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

[UMSTUDENT]

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.

100% agree. I can only imagine how costly those cartridges are.

[ERDoc]

The unit costs about $10,000. The troponin cartidges cost about $500 for a box of 25. For a chem8 it is about $329.

[dahlio]

BTW I hate the "well, what does it change in your treatment" argument that we see so often in EMS. Just because an assessment point doesn't lay directly at heart of a treatment decision does not mean that it isn't important. That is "technician" kind of thinking, not "clinical" thinking.

Now I'm not a Paramedic, nor any type of ALS provider, but I must say, this statement is absolutely true. I.E. Why do EMT-Basic's go in to detail asking about abdominal pain, whether it's dull, sharp, radiating. Why do we palpate it? Let's face it, it will not change our treatment (Oxygen and Transport). But it's one more thing that you can relay, and get an idea of what's going on with the patient. It just puts one more piece of the puzzle together, which in turn, saves time to find the other pieces.

Just wanted to point that out.

-dahlio

[Arizonaffcep]

Now I'm not a Paramedic, nor any type of ALS provider, but I must say, this statement is absolutely true. I.E. Why do EMT-Basic's go in to detail asking about abdominal pain, whether it's dull, sharp, radiating. Why do we palpate it? Let's face it, it will not change our treatment (Oxygen and Transport). But it's one more thing that you can relay, and get an idea of what's going on with the patient. It just puts one more piece of the puzzle together, which in turn, saves time to find the other pieces.

Just wanted to point that out.

-dahlio

It's not just a relay thing, although this is important. But, if you know what is going on with your patient, you can better prepare to head off potential calamity during transport.

[njmedic1485]

Reaper, your system is obviously more advanced than mine --- how does the location of the MI change your "field" treatment ?

Also with a confirmed STEMI I think more about adding some Lopressor.

[njmedic1485]

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.

Fiznat,

Getting follow up information back to the line troops one of the biggest ways to get buy in from the field, I can get information back with in 24 hours and our director publishes our STEMI alert times quarterly. It is an acceptable disclosure under the HIPPA QA/QI and education exemptions.

As a side note to anyone else using the LP 12, do you routinely leave the chest cables hooked up to take advantage of the trending capabilities?

[Doczilla]

To say, "this won't help me during the transport" is too myopic. EMS providers MUST think of themselves as part of the continuum of care from the field to the ER and the OR or cath lab or patient care floor. 12 lead may not improve care during transport, but it cuts down overall on door-to-balloon times. Same thing with trauma team activations. There is no trauma team that will meet you by the side of the road, but patient care improves nonetheless by expediting specialized trauma care. Interventions performed in the field (aspirin for ACS, beta blockers, etc.) help ensure that they are performed in a timely manner. Proper assessment ensures appropriate transport destination, and also provides vital clues that may affect disposition. I have admitted patients based solely on findings by the EMS crews, such as the patient who had an abnormal EKG in the field that normalizes by the time they reach the ER. This piece of data is the difference between a patient going home after 2 negative sets of enzymes, maybe to die, and the patient being admitted and subsequent cath. You may not always see the difference you make, but we do.

'zilla

[WelshMedic]

Dubble posting.

[WelshMedic]

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.

You forgot the heparin, plavix and aspirine prehospitally on-route to the cath-lab

[zippyRN]

does the Istat magically detect a reliable troponin level far sooner than any other test ?

it has to be a system wide view which is where the 'evils' of socialised healthcare are extremely beneficial .

if the paramedics are able to interpret and communicate findings send a copy of the 12 lead to the recieving facility then forget door to needle for ither lytics or PPCI and start thinking 'call to needle' or 'pain to needle'