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

[crotchitymedic1986]

It doesnt do it any faster, but it does it in the field --- so again, much like an initial H&H after trauma, the receiving facility would have an initial level to compare to. Those that are already elevated, but have asymptomatic pain, might be discovered and not left at home or told to follow up with private MD. It does most of the basic lab levels (chem panel, CBC, Enzymes, etc..), the last time i used one, which was 8-10 years ago, it didnt do drug levels or a CMP (if that is the right letters for the CHF test).

[crotchitymedic1986]

ERDoc, i respectfully disagree about having a white count in atleast one specific area -- pediatrics. Medics and EMTs are sometimes to quick to diagnose fever as something minimal (ear infection / teething) with no data to back up that theory (we cant even look in their ears to see if they are red). I have a friend who worked in the local pediatric hospital ER, and he claimed that they easily did LPs on about 10-15 kids per week. Although the majority were negative, the test was indicated by the high white count, usually found at the doctors office or other ER, after an EMS crew told the parents to give tylenol q4 and follow up with their pediatrician. He claimed that the vast majority that tested positive for menengitis did not have a petechia rash or stiff neck (he claims that is usually a late sign, you also have to figure in the fact that small children are scared and reluctant to admit symptoms if they are old enough to understand). It might also be useful with some nursing home patients to determine a diagnosis. Will it change field care, probably not, but it might mean someone gets transported that wouldnt have before --- damn, did i just make the point for keeping 12-lead ? hate it when that happens.

[spenac]

(we cant even look in their ears to see if they are red).

Why not? I have been checking patients ears since I got into EMS many years ago as an ECA (Texas First Responder).

[crotchitymedic1986]

no otoscope -- should have said eardrums

[Ridryder 911]

I am appalled at the responses. Seriously folks if don't know the value of twelve lead use in the field then I have serious doubts of understanding cardiology. C'mon its not rocket science teaching and understanding twelve leads, as well if you do not see the whole picture of an ECG then why even hook them up on a simple monitoring lead? Really, what good or what does that really tell you?

If your medics do not understand the physiology and do not know the differential treatment from an inferior wall and being able to see a post inferior then you have problems. Your medical director should be one of the first to endorse a better diagnostic tool.

Times are changing. Alike trauma center alerts and appropriate transports there will be designated and appropriate centers to handle coronary problems. At this time we our investigating a "heart alert" in which will be similar to trauma alerts to inform the EMS unit which hospital will receive the coronary patient. Alike trauma registry, there is going to be a heart registry as well. Not all hospitals have interventional therapy in the cath lab and thrombolytics have fallen out of favor if they can be in a cath lab in a reasonable time.

Although I agree relying upon technology is foolish, not using it appropriately is reversing and stagnating the system. I now see hospitals paying attention to prehospitals twelve lead due to the new JCAHO twelve lead rule, and with the technology of blue tooth and faster transmission makes it easier and more clear.

I believe we will be dong more tests and yes, will have to increase the responsibility (of course increase the education) of the Paramedic. I-stat will help make the determination of potential versus non-AMI. Again, the role we will be playing will be much different than it is now, with the increase of no available beds in hospitals and ED's EMS will be more a screening process.

R/r 911

[spenac]

no otoscope -- should have said eardrums

Why not? That is a basic piece of equipment. If you ever work for another service w/o get your own or demand the service get one.

[Dustdevil]

No offence, Crotch, but I'm getting the feeling you spent your career up north. You seem to have missed a lot of what is going on in real EMS over the years.

[crotchitymedic1986]

I am learning that quickly through this forum, thought i had it pretty good -- guess you dont know how poor you are till you meet some rich people. You guys obviously work for some pretty cutting edge services.

[JakeEMTP]

No offence, Crotch,

You can't say crotch here.

[spenac]

I am learning that quickly through this forum, thought i had it pretty good -- guess you dont know how poor you are till you meet some rich people. You guys obviously work for some pretty cutting edge services.

One of my services is in one of the largest USA countys but is also one of the poorest. In fact this past month they could not pay the phone bill and it got cut off.