magnets and EMS

[Just Plain Ruff]

Does anyone out there carry magnets for defibrillators and pacemakers?

I had a patient tonight that his implantable defib went off 5 times while I was treating him. NO precurser - sinus rhythm throughout.

Does any out there carry the doughnut magnets on their trucks?

If you do do you have protocols to use them? If you do have protocols is it possible for me to get a copy of your protocol.

[spenac]

I had a patient that carried his own, but have not heard of a service carrying. Might not be a bad idea.

[Dustdevil]

Only one place I have ever worked carried magnets, and it was a 2-ambulance, rural, county-wide, hospital based EMS in Texas, staffed by medics and ICU nurses. This was in the 1980s. Never seen or heard of them being carried elsewhere.

Protocols? Well, sort of. There were no specific procedures written for the use of the magnet. Our entire protocol book was three pages long. First page was a letter signed by the Medical Director, authorising us to perform any medical intervention we deemed necessary for our patients, within the standards of currently accepted medical practice. The second and third pages were our drug list. So no, there weren't any real written procedural protocols for use. We were just expected to know what we were doing.

[JPINFV]

We were just expected to know what we were doing.

But but but without a flow chart or number ordered list how is any treatment supposed to be accomplished? :twisted: 8)

[VentMedic]

EMS has failed to continously educate providers on the many different technologies (AICD, VAD, LVAD) available to the patient at home. The text books are still stuck at a 1980s level. Thus, it is difficult to a write blanket order for "one" type of whatever. You now have many combinations which also must be taken into consideration. Hospitals do strive to educate the patient and family in their own specific care so that they may better educate those that come to their assistance in emergencies to do no further harm and how to treat the patient and the device. Of course, it is not uncommon to hear horror stories like "I'm doing it my way because I am the Paramedic and I don't care if you did have 6 months of education understanding you own heart device".

[Arkymedic]

I had my first experience with one last year. We were dispatched to a pt that was continuously being shocked. I had never dealt with one and was not taught anything about them in paramedic school. The guy told me what needed to be done and every time he moved his arm, he was shocked by his implant. When I called MedCtrl and the emergency # listed on the card, all they told me was to hurry up and get to the hospital. When I arrived, MedTronic had a guy there in the ER with his machine ready to adjust it. He gave me some basic info, taught me what to do, showed me why it was going off, and gave us a magnet for future use. After that I had three more in one month. Long story short, there is one on my old truck at the service I use to work for but no protocol.

Does anyone out there carry magnets for defibrillators and pacemakers?

I had a patient tonight that his implantable defib went off 5 times while I was treating him. NO precurser - sinus rhythm throughout.

Does any out there carry the doughnut magnets on their trucks?

If you do do you have protocols to use them? If you do have protocols is it possible for me to get a copy of your protocol.

[Arizonaffcep]

Currently, the only doughnut magnet I have is the MRI. But seriously, I don't know enough about them, other than what they do as opposed to how they function to be comfortable with that. With proper education...maybe, but as of now...no thanks.

[Richard B the EMT]

STOP!

Would someone please tell this EMT what you are talking about, "Donut Magnets" and their relationship to implanted defibrillators?

[Doczilla]

A "donut magnet" is a round magnet that can be used to temporarily modify the function of implantable defibrillators and pacemakers. When placed over the device, it will disable the defibrillator/cardioverter function and prevent inappropriate shocks (of course, it will also prevent appropriate shocks as well). Inappropriate shocks are most commonly caused by "oversensing", which is when the AICD incorrectly senses that the heart is in v-fib or v-tach and provides a shock. For pacemakers, the magnet will convert the pacemaker from "demand" pacing mode to "fixed" pacing mode, i.e., it will pace at the set rate no matter what the heart is doing. This is to correct the most common pacemaker error, also known as "oversensing" when the pacemaker incorrectly senses impulses and interprets them as beats. Thinking that the heart is beating appropriately on its own, it doesn't provide a pacing impulse when needed. By converting to fixed mode, it will pace the heart at the set rate (which is set when it is implanted, but can be modified by a tech with a computer hooked to a magnet, usually 70 BPM).

Once the magnet is removed, the AICD or pacemaker returns to its previous settings. Placement of a magnet does not permanently change the device settings.

I think having a magnet on the ambulance is probably of little benefit. I apply these very infrequently, perhaps 3 times in the last 4 years.

'zilla

[Richard B the EMT]

Thanks for the clarification. I read Donut Magnet, and I was thinking some promotional refrigerator door doohickey from Dunkin' Donuts!