BLS 12 leads

[Niftymedi911]

Even in rural use it is asinine. The proper protocol's and education takes, time, money, and a medical director willing to put his name on someone who's had 3 months of first aid and can drive a bone box. I would definately reccomend everyone BLS to attend a 12 lead course, but like someone else had said, they would just do enough to take the training etc. In the most rural areas, sometimes your lucky even if you get an ambulance with someone skilled and educated enough to know what to do. Now, adding 12 leads to an EMT cirriculum or protocol. What's next EMT field intubations????

Simple senario, if your BLS you respond to a chest pain. He looks like shit and you recognize you might have a STEMI alert. You slap the leads on and do a 12-lead. You recognize an inferior wall MI. (if you paid attention in class). As an EMT, what do you do now. Besides rapid transport and oxygen, what other procedures can you provide??? If you didnt have a 12-lead what would you have done different??? Nothing you handle to call the same exact way. There's no point for BLS 12 leads. If you want the skills, grow some balls and GO TO MEDIC SCHOOL!!!!! Quit trying to muddy the Paramedic/EMT scope of practice. We can never be fully considered professional with people trying crap like this.

[threebl9mice]

Um, exactly when were medics required to get a 12 lead before defibrillating and/or where are novices with no medical training allowed to electrocardiovert? I honestly think that comparing 12 leads to manual defibrillations to using an AED is a non-sequitur.

You're right, technology is here to stay and it is about patient safety and care. So tell me, what part of an EMT-Basic's education prepares them to interpret or even make use of the information provided by a 12 lead ECG?

I said with an in-service pcp's can understand...not diagnose that there is a problem that needs higher level of service and adjust course and activate other links in the chain of survival...mabe even bypass the small country hospital and link up with the medics on the life flight. we do that right now for stroke protocol... some times I think these posts are useless...so many protocols for so many services, governing bodies, and differing states/provinces and countries. why bother arguing as we are talking about pears and oranges...

[JPINFV]

Umm, call me a little ignorant, but what other type of shocking is any paramedic or lay provider doing besides cardioverting (I'm pretty sure you need to be a medic for that one) or defibrillating (AED or otherwise). I am assuming that you did not mean either pacing or electroshock therapy when you posted that.

Um, ok, so what sort of life saving procedure can a basic do after obtaining a 12 lead that they can not interpret? Oh, they can drive to the nearest available advanced emergency provider (hospital or medic). Hmm, it does seem, on further thought, that driving the patient to the hospital could be done without such a treatment. Considering that a basic's ability to treat a cardiac patient ends at O2, I don't really see a basic bypassing the nearest emergency facility for a cath lab as being an option.

Ohh, primary care paramedics. Considering that PCPs were never mentioned in either the original post of this thread or by you, and that some provinces, to the best of my knowledge, do utilize the EMT-Basic, I made the connect between "BLS" and EMT-B. This is, of course, ignoring the fact that ALS/BLS only exists in EMS. Then again, there seems to be a wide variety of what PCPs can do depending on their location.

[canadian_ghost]

Even in rural use it is asinine. The proper protocol's and education takes, time, money, and a medical director willing to put his name on someone who's had 3 months of first aid and can drive a bone box. I would definately reccomend everyone BLS to attend a 12 lead course, but like someone else had said, they would just do enough to take the training etc. In the most rural areas, sometimes your lucky even if you get an ambulance with someone skilled and educated enough to know what to do. Now, adding 12 leads to an EMT cirriculum or protocol. What's next EMT field intubations????

Simple senario, if your BLS you respond to a chest pain. He looks like shit and you recognize you might have a STEMI alert. You slap the leads on and do a 12-lead. You recognize an inferior wall MI. (if you paid attention in class). As an EMT, what do you do now. Besides rapid transport and oxygen, what other procedures can you provide??? If you didnt have a 12-lead what would you have done different??? Nothing you handle to call the same exact way. There's no point for BLS 12 leads. If you want the skills, grow some balls and GO TO MEDIC SCHOOL!!!!! Quit trying to muddy the Paramedic/EMT scope of practice. We can never be fully considered professional with people trying crap like this.

I agree. If you are, even in a rural area a 12 lead for BLS will not benifit the patient any. It will take you time to get the leads on, and then once you do get them on (hopefully correct) how is the reading going to help you OR the patient? Your protocols wont be any different so you wont be able to admin. any cardiac drugs or do anything other than shock the patient if they crash on you. Dust made a good point in the price it can cost to but ONE unit you could buy several AEDs or pay the wage of another BLS medic. If your itching to use a 12 lead then advance your skill. Go become ALS. Where I live ALS is not an option, there are no ALS cars here. But in our city your 10-15 minutes max from the hospital. So in My case a 12 lead would be a waste of time/money and the problems it would bring.

The only pro i can see to having BLS use a 12 lead is that the ER nurses and docs may take a glance at it and work with it, but other than that i say no.

[ccmedoc]

And the winner is...

In other words, in all but the rarest circumstances, it's a horrible idea. Do you know how many AEDs or sets of body armour you could buy with the cost of just one Lifepak 12 that provides you no benefits for your patients? You could hire another full-time medic for a year with that money. NO justification for that. Any manager that even considers this nonsense needs to be sacked.

Agreed..Can they be taught to aquire a 12 lead accurately? Anyone can..techs do it in the ED with essentially no previous medical training. The facts are that it serves no beneficial purpose. A 12 lead can be aquired by a paramedic in less than two minutes if need be and interpreted as fast. For the cost of outfitting basic ambulances with a lifepack 12 in every ambulance, employ and deploy a few additional medics and more benefit will be realized..IMHO

This is new and valid technology. medics use to have to transmit to the doctor the ecg and then wait for the ok to shock....now a novice w/ no medical training is shocking....

No rhythm analysis needed for AED. This "No medical training" comment does not hold water with the machine and subsequent algorithm analyzing the rhythm for the provider. When the box says shock...shock. I dont, in recent recollection, know of any advanced provider needing to call ahead for defibrillation instructions. Johnny and Roy do not count.. :roll:

Saying a lifepack has an AED function will not fly either as the expense far outweighs the benefit of EMT generated 12 leads..

[a_shane2_go]

Now my knowledge of ECG's is limited but i'm a PCP from alberta (EMT) right now we are able to place but not interpret 12 leads. However would people agree with new monitors (Zoll M series.) You are able to hold down the record button and get a print out of Lead I, II,III aVR aVL and AVF from the 4 lead, and the machine then also goes into diagnostic mode. (The sensitivity required for ALS to "diagnose" an MI.)

So would this not be a good advantage to the EMT/PCP who is able to admin Nitro/ASA? Or at least to the receiving hospital? When the procedure takes an extra literly, 4 seconds holding the record button from a regular 4 lead. However as it stands the administration of ASA and Nitro is only based on a "Chest pain protocol" right now in AB for EMT's to use nitro/asa.

So this is technically in the scope of an EMT/PCP (as it is not a true 12 lead, no V1to V6 leads) and only uses a 4 lead, however has the advantage of a 12 lead's sensitivity?

[chevy]

Point 1: BLS medics ARE being taught 12 lead interpretation for diagnosis purposes

Point 2: In some areas, this knowledge is being used to bypass the ER and go straight to the Cath Lab with great results

As we are an evidence-based profession:

see 17 Jan 2008 New England Journal of Medicine

http://content.nejm.org/cgi/content/abstract/358/3/231

it's conclusion: "Guideline door-to-balloon-times were more often achieved when trained paramedics independently triaged and transported patients directly to a designated primary PCI center than when patients were referred from emergency departments"

From real life: 2 weeks ago, male with CP meets us at door. We get him to lie on the stretcher asap. Take 30 sec's to place 12 leads, run a strip. Clearly a STEMI. Call the Cath lab - from the hallway outside his apt. Leave lights/siren, bypass the ER. Patient gets catheterization done BEFORE we get our paperwork complete.

Thats what I call making a difference.

[Rural Medic]

OK,,,,We use a 12 lead and i'm a PCP,THERE ARE BENEFITS.

Depending what you are using a 12 lead can be faxed directly to the emerg.dept. and the doc can tell what is going on.In a rural area that may mean by-passing a small rural hospital to get your patient into a CCU. at a larger center without wasting time stopping at the regular hospital.Depending on your medical control he/she may advise the adminstration of drugs normally outside our normal protocols.Anything that helps patient treatment is a plus,so in my book ,,,,,12 lead helps,go for it.

[Dustdevil]

Wrong. We don't treat EKGs. We treat patients. You would know that if you had an advanced education. Advanced decisions should be made by those with advanced education, not those making uneducated assumptions.

Anything that helps patient treatment is a plus,so in my book ,,,,,12 lead helps,go for it.

Anything that takes EMS back to 1972, and relegates us to nothing more but the "hands of the doctor" is a negative in my book. It's neither good for the patients nor good for the profession.

Saving the hospital five minutes by wasting ten minutes in the field isn't really a benefit. Do the math.

[AnthonyM83]

Strange, that's not stopping LA or Orange County, CA from having their medics get a 12 lead for the machine evaluation.

Haha nice. The other day, a medic read the printout "Let's see...Abnormal EKG...Possible left anterior block...whatever the F that is...yup, no star star star acute MI, we're good, BLS".