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BLS 12 leads


mobey

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Yeah... I mean physicians are misleading members of the public too then! When I go to the ER I expect to be getting an emergentologist.... I find it despicable that I may be getting just a GP who is working in the ER instead. They all call themselves physicians and it is wrong.

[/tongue in cheek]

How is this different?

They are physicians they are not Emergency specialists. I actually hate when I take my patients to the hospital and find a GP rather than an experienced ER doc. Patients think they are getting same care but they are not. It is deceptive practice.

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Not sure how it's relevant to a discussion on BLS and 12 lead given that during my BLS training we were taught to apply and interpret 12-leads for purposes of bypass decisions (Thanks to all who pointed out that Cath Labs are not always accessible from where they work - this is an urban luxury I'm afraid).

It's wholly relevant to the discussion because this whole discussion is about the pros and cons of BLS 12-leads. And the theory being put forth here is that BLS running 12-leads is an obstacle to the implementation of ALS service in your area. In terms of mortality and morbidity, a much greater good would be done for your community by employing ACPs than by giving 12-leads to PCPs. Anything that gives your community a false sense of security regarding the capability of their paramedics is not a benefit. It's just an obstacle to progress. And, if few of your people are progressing to ACP school in a timely fashion, then that would be obvious evidence of that obstruction.

To answer your question - Nothing (the $15.5K in tuition gives one indigestion though).

LOL@indigestion

Well, congratulations on taking that next step. That's what I was hoping to hear from you. I wish you the best of luck. But, like every other intelligent medic I've ever known, I think when you graduate, you'll have a much clearer understanding of the theory I am discussing here. I think you'll end up saying to yourself, "wow, I can't believe I was out there practising without knowing all this stuff before!" And you'll also end up with an understanding of why I say that simply sticking more skills in the hands of BLS providers is not a tenable solution.

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In terms of mortality and morbidity, a much greater good would be done for your community by employing ACPs than by giving 12-leads to PCPs.

Although I would never disagree that a more trained and better educated provider is better, do you have any studies that back this statement up? I'm just curious because the OPALS studies here in Ontario have not been showing as huge a benefit (in fact no benefit in some cases) of having ACP care as I would have expected. There is an observational study being run at various services in Ontario that will be beginning in the future that is evaluating the use of 12 leads by EMS. I can't recall whether it is strictly PCP or if it is ACP use also, but it will be interesting to see what that shows in terms of morbidity and mortality.

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Although I would never disagree that a more trained and better educated provider is better, do you have any studies that back this statement up? I'm just curious because the OPALS studies here in Ontario have not been showing as huge a benefit (in fact no benefit in some cases) of having ACP care as I would have expected. There is an observational study being run at various services in Ontario that will be beginning in the future that is evaluating the use of 12 leads by EMS. I can't recall whether it is strictly PCP or if it is ACP use also, but it will be interesting to see what that shows in terms of morbidity and mortality.

Ah, but the OPALS study to this point has been based mainly on trauma and I agree that there isn't that much difference. If you read into the study a little further though, you will see that the fourth part of the study involving cardiac isn't yet completed, and they are saying there is some benefit to ALS providers. Also, when patients are in respiratory distress the study states there is a benefit to advanced providers.

reference:

http://www.ctv.ca/servlet/ArticleNews/stor...0421?hub=Health

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Although I would never disagree that a more trained and better educated provider is better, do you have any studies that back this statement up?

Nope. It's simple statistical math. More people suffer and die from cardiac arrhythmias and other medical conditions that require ALS intervention than those who die from AMIs. Every run analysis I have ever done at any agency has revealed this.

That's sort of the point. Tossing 12-leads out there simply for diagnosing the occasional AMI, yet being wholly incapable of treating it, creates an illusion of progress when, in fact, you are ignoring the vast majority of ailments that afflict your population. And thus, addressing those other ailments would reduce mortality and mordity more significantly than those BLS 12-leads.

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Nope. It's simple statistical math. More people suffer and die from cardiac arrhythmias and other medical conditions that require ALS intervention than those who die from AMIs. Every run analysis I have ever done at any agency has revealed this.

Good to know.

That's sort of the point. Tossing 12-leads out there simply for diagnosing the occasional AMI, yet being wholly incapable of treating it, creates an illusion of progress when, in fact, you are ignoring the vast majority of ailments that afflict your population. And thus, addressing those other ailments would reduce mortality and mordity more significantly than those BLS 12-leads.

The one problem with this is that although the EMS provider may not be able to alert their treatment based on the 12-lead, if it decreases the time to definitive care then it could decrease morbidity and mortality.

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Ah, but the OPALS study to this point has been based mainly on trauma and I agree that there isn't that much difference. If you read into the study a little further though, you will see that the fourth part of the study involving cardiac isn't yet completed, and they are saying there is some benefit to ALS providers. Also, when patients are in respiratory distress the study states there is a benefit to advanced providers.

reference:

http://www.ctv.ca/servlet/ArticleNews/stor...0421?hub=Health

That is a valid point about the ACS part of the study not being completed yet. Wasn't it also OPALS who showed no benefit of ALS care for cardiac arrest outcomes or was that someone else?

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That is a valid point about the ACS part of the study not being completed yet. Wasn't it also OPALS who showed no benefit of ALS care for cardiac arrest outcomes or was that someone else?
Yes it is the same study. But lets be honest. The survival rate of any cardiac arrest is dismal. Quite frankly, dead is dead. It is very seldom that we as providers actually bring people back who have arrested. Does it happen? Of course it does. The numbers in the study are so close that they inconsequential.

Where the study does show the need for ALS was in the living. Respiratory and cardiac patients do better with ALS interventions.

Sorry for the highjack. I thought perhaps mistakenly, this was relevant to the thread.

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That is a valid point about the ACS part of the study not being completed yet. Wasn't it also OPALS who showed no benefit of ALS care for cardiac arrest outcomes or was that someone else?

Correct. And that is the reason that OPALS was a really insignificant study, in the grand scheme of things. It is also the same reason that this idea of BLS 12-leads is insignificant. They are both myopic and short-sighted, failing to take the big picture into account. It reminds me of the old Johnny Cash song, "One Piece At A Time", where he assembles a new car for himself with parts stolen while working at the auto factory for thirty years. Yeah, you get a car cheaper that way, but the results are nothing to be proud of.

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Correct. And that is the reason that OPALS was a really insignificant study, in the grand scheme of things. It is also the same reason that this idea of BLS 12-leads is insignificant. They are both myopic and short-sighted, failing to take the big picture into account. It reminds me of the old Johnny Cash song, "One Piece At A Time", where he assembles a new car for himself with parts stolen while working at the auto factory for thirty years. Yeah, you get a car cheaper that way, but the results are nothing to be proud of.

I got it one piece at a time and it didn't cost me a dime.

Good use of a classic song to illustrate a point.

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