Remove 12 Lead from ambulances ???????

[ERDoc]

How about this? 12-leads and an I-stat to give you an initial troponin. If either are positive on-scene you call the interventional cardiologist and let him make the decision to cath. If both are negative then off to the closest hospital.

[UMSTUDENT]

UMSTUDENT,

Do you have the opportunity to follow up on patients where you work? If I've got a patient that I'd really like follow up with, I just write down the basic info and one of the nurses or docs will look him/her up in the system later on. This has helped me quite a bit. It is nice to hear "how things turned out" and to apply that experience to the next patient. It is up to the individual medic to find out for him/herself, though.

Nope, unfortunately this is an area where our system fails miserably. We have problems getting a face sheet around here, let alone actual patient care information once we drop them off. This is pure ignorance on the part of the staff at this particular hospital. At my part-time job, in a different jurisdiction, I have considerably more success.

Again, I think if most paramedics knew the continuity of care once they dropped a patient off they'd be much more inclined to understand why education is so essential. I have a respect for the process only because I spent significant amounts of time throughout hospitals during my clinical education. And because I'm curious by nature...

[crotchitymedic1986]

That is the day i am dreaming of -- ISTATs that are cheap enough to be put on ambulances -- think about troponin levels, knowing an intial H&H right after a traumatic event, being able to get a white count to determine if an illness is viral or bacterial. That will be a happy day in EMS.

[UMSTUDENT]

How about this? 12-leads and an I-stat to give you an initial troponin. If either are positive on-scene you call the interventional cardiologist and let him make the decision to cath. If both are negative then off to the closest hospital.

I was going to go there, but not everyone seems to be on that page. A local flight program utilizes I-Stats. Would love to have one, but those "dang fangled blood labs are for fools!" Get my drift? I think we can both agree that more educated paramedics would give way to a lot of solutions.

[Dustdevil]

Technology won't fix stupid. We're a VERY long way from ISTATs. We're still a very long way from paramedics understanding the technology they already have.

[medic_texas]

Right on Dust.

ERdoc, thanks for the links and the input. It's good to have a M.D. to help us (and mostly the uneducated and BLS level paramedics out there) understand why 12-lead interpretation is important for recognizing and treating AMI (which occur on different areas of the heart FYI).

I'm very tired of the trolls trying to push their opinions and thoughts about why they don't need 12 lead ECG.

If you don't want to advance the profession, become a truck driver or a hair dresser.

[spenac]

If you don't want to advance the profession, become a truck driver or a hair dresser.

But those require more education than EMS.

[EMS49393]

Here's your real-life example.

I was educated by Bob Page. Although I no longer work at St. John's, I will ALLWAYS be a St. John's Paramedic.

I had a 48 year old male patient develop chest pain while mowing his lawn. His wife activated 911. The patient got a 12-lead within 2 minutes of arriving on scene that showed a HUGE anteroseptal with lateral involvement STEMI with reciprocal depression. He was loaded into the ambulance and en route to the ER within 10 minutes on scene. A cardiac alert was called. Transport time was less than five minutes. The patient remained in the ER long enough for orders and placement of the cath lab team, which took less than 5 minutes. He wouldn't have been in the ER that long, but apparently we moved much faster than the team.

The patient was discharged three days later with three stents to a very grateful wife.

Pre-hospital 12-lead and the ability to rapidly interpret and quickly move with this patient saved his life, not a doubt in my mind, and not a doubt in the cardiologists mind. There were other factors in this save, however I doubt it would have been possible without the above.

The service I moonlight with has intermittent 12-lead capabilities. The medics do not know how to read a 12-lead, and all the area ER docs know this. Couple that with not being able to transmit, and it doesn't matter what the ECG says, the ER will do it's own workup, often costing the patient more than 20 minutes in valuable muscle. I'm pretty lucky, most of the nurses taking my report know me, and they know that if I say a patient is having an acute MI, they are the real deal. If I transport to the hospital I work at, I get what I need in rapid fashion.

With that being said, 12-leads are only useful if the paramedics are educated and able to interpret them and initiate a rapid transport with correct treatments. NTG shouldn't be given in a 400 mcg dose if the patient is having an inferior AMI. They should be dosed with a drip that can be titrated to effect and blood pressure. Unfortunately, I doubt more than a handful of medics in my current know that. Blood pressure is like a toilet, once you start flushing, it's damn near impossible to push the water back up into the bowl.

Quality education equals the ability to become more progressive providers.

Funnily enough, I was talking to one of the nurses at work today about education. I told her that if I ever had a heart attack, I'd hope to God I was in Springfield, MO when it happens.

[ERDoc]

Dust, stop crushing our dreams, man. Crotchity, I would have to respectfully disagree with the need for an H&H or WBC. The H&H of a trauma pt is not going to change from the field to the ER (depending on how much fluid you are able to dump in before you get to the ER). Your H&H will remain fairly stable (assuming no IVFs) for about 24 hours, when the body starts to re-equilibrate for the lost volume. A WBC will not tell you much of anything, unless it is extremely high or low. I cannot see much utility in having one in the field. I think if you have to choose the most useful iStats for your limited room I would go with the troponin, ABG, chem 7 and a pregnancy test. While we're at it, let's throw in an US machine.

[spenac]

While we're at it, let's throw in an US machine.

Dr Spears has tried to get it more into the field.

http://www.911sono.com/ems_ultrasound_homepage.htm