Sending 12 Leads

[flipper123]

Seriously, I wonder if, instead of spending the $$$ for upgrading your transmission system, you spent the $$$ on training your medics to a higher level of ECG recognition, would that be better spent?
Have the local cardiologists get involved, have them make up a test with questions and sample 12 leads; if your group can show the ability to read the 12 leads as well as the ED docs, why spend the $$$ on technology that will need to be maintained/serviced, updated, and replaced?
Look through Medhost, there are multiple (ie lots) of studies showing medics are fully capable of recognizing STEMI as well as ED docs.

Spend the money on your people, not gadgets, you'll be much better medics in the long run!

[dr-exmedic]

Originally Posted by flipper123

Seriously, I wonder if, instead of spending the $$$ for upgrading your transmission system, you spent the $$$ on training your medics to a higher level of ECG recognition, would that be better spent?
Have the local cardiologists get involved, have them make up a test with questions and sample 12 leads; if your group can show the ability to read the 12 leads as well as the ED docs, why spend the $$$ on technology that will need to be maintained/serviced, updated, and replaced?
Look through Medhost, there are multiple (ie lots) of studies showing medics are fully capable of recognizing STEMI as well as ED docs.

Spend the money on your people, not gadgets, you'll be much better medics in the long run!

Tell that to the people spending the money. They can spend a few hundred bucks on a gadget that won't need to be replaced for a few years and throw the responsibility on a doc, or they can spend hundreds of dollars in OT to train the medics, and hundreds more to retrain them every year to keep them up on things...plus be on the hook for whatever happens. (I still hear to this day that we're "practicing under the doc's license" and I think it really keeps us from thinking of ourselves as independent--yet another impediment to a true EMS profession.) I think you can see which is the easier (if not truly "better" in my mind) choice for many service directors.

[Firemedic 61]

Originally Posted by flipper123

Seriously, I wonder if, instead of spending the $$$ for upgrading your transmission system, you spent the $$$ on training your medics to a higher level of ECG recognition, would that be better spent?
Have the local cardiologists get involved, have them make up a test with questions and sample 12 leads; if your group can show the ability to read the 12 leads as well as the ED docs, why spend the $$$ on technology that will need to be maintained/serviced, updated, and replaced?
Look through Medhost, there are multiple (ie lots) of studies showing medics are fully capable of recognizing STEMI as well as ED docs.

The cardiologists at our local cardiac hospital don't trust the interpretation of the ED Docs, let alone a paramedic. Training with them, which we have done, is not going to change the way they operate. If spending money on "gadgets" gets the cath team ready faster than isn't that what is really important?

[flipper123]

Guess I just didn't realize it's that much of a problem nationally. Our county has plenty of lousy medics around, but they are still allowed to read a 12 lead and make the call.

[dr-exmedic]

Originally Posted by flipper123

Guess I just didn't realize it's that much of a problem nationally. Our county has plenty of lousy medics around, but they are still allowed to read a 12 lead and make the call.

And there are plenty of systems doing weirder things. I remember reading about somewhere that the medics were allowed to read the machine interpretation of the ECG over the radio or phone, and they would literally activate the cath lab (or not) based on whether the monitor printed "ACUTE MI SUSPECTED" across the top. Wish I could remember where....

[FFmedic13]

If training was what we needed, I would support it, but the majority of our medics are very proficient with 12-Leads on the EMS level. Most of the cardiologists at our local center are narcissists. I don't mean that as a cheap shot either... they really are. To ask them for cooperation in training or evaluating low-life paramedics would be a slap in the face to them.

Putting pride in my profession aside, if sending them my 12-lead will get that ACS patient in the cath lab quicker, I will do everything I can to make it happen.

[RemptyP]

My service has worked with Cardiology and the ED to drive the Cath Lab activation. We have a very pro active medical director. Perhaps it is time to educate the Cardiologists as to the abilities of prehospital providers.

[TomB]

Originally Posted by dr-exmedic

And there are plenty of systems doing weirder things. I remember reading about somewhere that the medics were allowed to read the machine interpretation of the ECG over the radio or phone, and they would literally activate the cath lab (or not) based on whether the monitor printed "ACUTE MI SUSPECTED" across the top. Wish I could remember where....

Los Angeles.

[emt161]

Originally Posted by TomB

Los Angeles.

Which should surprise no one.

[TomB]

It's easy to criticize something you don't understand. The STEMI system in Southern California has been hugely successful by almost any measure. If it's so important for paramedics to be able to interpret a 12 lead ECG, then why isn't a core part of the paramedic curriculum? The GE-Marquette 12SL interpretive algorithm gets a bad rap. It has a high specificity when it gives the ***ACUTE MI SUSPECTED*** message, and a high specificity is important when you're regionalizing STEMI care, for a variety of reasons. Where I live, we have the ability to transmit the 12 lead ECG to the emergency department using the Lifenet Receiving Station, but we don't have to decided what hospital to transport the patient to, because our receiving hospital is capable of performing primary PCI, even though they have to call in the cath team during off-hours (nights, weekends, holidays). However, they don't activate the cath lab while EMS is still in the field to take advantage of parallel processing. I'd love it if they'd activate the lab based on the ***ACUTE MI SUSPECTED*** message. Right now, they won't activate it with a copy of the ECG in their hand. There is no "one size fits all" solution to STEMI care, and Southern California should be applauded for finding a solution that works for them. All of us should advocate for higher educational standards in EMS. Many paramedics can identify an obvious STEMI, but from what I've seen, it's a small minority that call tell the difference between LBBB, paced rhythm, LVH, benign early repolarization, pericarditis, hyperkalemia, and ventricular aneurysm (along with the associated repolarization abnormalities), as well as how to identify AMI in the presence of those abnormalities. It's easy to blame other people for our lack of education in this area, but at some point we need to look in the mirror, take charge of our profession, and get our house in order.