BLS 12 leads

[AnthonyM83]

Does knowing the results of an EKG (based on hospital transmission) affect treatment?

It affects which hospital they're going to . . . closest receiving or cath lab hospital...

[rock_shoes]

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.

Sounds like the service you're working with made good use of what your PCP's are taught. I think the confusion for our American counterparts is that we consider PCP to be a BLS level of care. PCPs are taught to interpret 12-leads. The problem comes from the fact that the older PCPs were not taught this and have never been upgraded. Also PCPs who were taught then never get to apply the skill lose it. It's one of those use it or lose it things. I don't buy the lowest common denominator argument. The lowest common denominator needs to either up there standard or get out. I'm not a proponent of this "no medic left behind" crap that seems to perpetuate.

[tniuqs]

PCP's with protocols for ASA/NTG are a standard in Alberta. To properly rule out a RVI a 12 lead is helpful as a monitoring device.

Lets put this ALL into perspective for the United Nations of so called Paramedics shall we ?

dean83: your avatar states you are from Alberta yet the title of PCP does not exist here and although the gap training "allows" for AB EMTs to "assist" with asa and nitro this currently falls under the legislation of the Health Disciplines Act, and under a little phrase called "local medical authority" LOTS of strictly BLS services do don't have that latitude, your suggesting that this is across the province and it just aint true, in that sense your blowing smoke and we have been waiting (some of us longer that others) to advance into the future with the Health Professions Act ... maybe then with just a FEW Medical Directors we CAN standardize care.

btw EMT does NOT = PCP ..... BC PCP does NOT = Ontario PCP ! PERIOD.

Dust / mobey :

With a new government incentive's the hint of upgrading and standardizing to the Advanced Care Paramedic or in Alberta / EMT- P maybe a possibility. The capital purchase of the 12 leads may even be another hint in that direction, I am so hoping so. Unfortunately in some cases as in Mastattas the services providing care (do not have to follow the same rules i.e. taxes ... because they don't PAY taxes) and based on a special interest group's of which I absolutely disagree phylosophically) Yes, a very different topic but this manager may be projecting the possibility of 24 hour Paramedic service. I would wish them good luck with that, perhaps the manager should "not" be sacked maybe just smarter than the average bear, inside information or better funding available ?

A Logistic comment: TO door for balloon angiography is not a serious "REALITY BASED" concept in rural Alberta, northern Ontario, rural BC or damn near anywhere other than high density populations .......whereas Throbolytics are very viable option to advance Paramedicine, internationally and perhaps positively influence MANY lives. That said many many rural ALS services do not have Throbolytics on the cars let alone ALS providers, and in some cases even with Paramedics that are very capable, their GPs/ Medical Directors will not even consider this option .... well just YET. Some provinces are much closer than others in passing. If you are from AB and reading this PLEASE review the provincial Stroke protocol on the ACP website, just might be a good idea.

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.

Your kidding yourself, unless the difference to door is minutes and just look to availability of Cath teams "after hours" a newly study just released, hope the link works for you.

http://www.medicinenet.com/script/main/art.asp?articlekey=88872

Your scaring me you as can not treat ANY arrhythmias, as PCP/ EMT A or B. You can not support BP with pressers your so in over your head ! Is doing a 12 lead enroute a bad thing NO but choosing to go outside your protocols and administer drugs .... hope you have another job.... like would you like fries with that burger sir !

The plastic AED or SAED in my very critical opinion HAS held back the advancement and development for Paramedics IN North America .... PERIOD, as without these plastic brains Advanced Life Support would have been far better funded IMHO.

So chew on this for a second all those EMT-B and EMT-A and PCPs. You are not trusted to interpret V-fib or V-tach ..... that little plastic brain has to do that for you so please get real, but now you wish to interpret 12 lead without the proper background, education +++

Besides bedside cardiac enzyme markers are far more accurate indication of possible infarct, as ECG changes can be late signs, (well discussed in another thread) no one has mentioned this and this option could be a far more cost effective means to provide improved care the the Chest Pain patient ?

Comments svp?

Yet on the other side of the WORLD the voice of true reason and hopefully the future in the "COLONIES" the studies done in the UK are "bloody brilliant" WE in north America are so arrogant to believe that we are superior..... I am personally hold my head in shame !

We routinely have BLS doing 12 leads here, and interpreting if they feel able - it also gives them guidance as to whether they call for paramedic backup or not - we thrombolyse pre hospital also, So I think a positive YES - where indicated - any grade should be doing 12 leads.

CHEERS: Andy show us the way !

[chevy]

Dust. Not sure where you are working but bypassing a hospital by interpreting a 12 lead and ending up at the right destination in the first place does not save 5 minutes at the hospital by spending 10 minutes in the field. Getting into an ER, having them do an ECG, deciding to transfer and then getting that done is a time period that is measured in hours, not minutes - at least in our part of the world.

Actually the 12 leads don't consume any time worth arguing over. The vast majority of the time we do them enroute. We have to attach the 4 pads for regular monitoring so the extra 6 pads take another 10 seconds. Push the Button, look at the results. Redirect if necessary. My opinion is that if I'm going to attach a cardiac monitor, then they get a 12 lead as there is no downside, aside from losing a few more chest hairs. In the past 3 months, we have seen an 8 year old and a 26 year old who were diagnosed by Paramedics as having coronary artery blockage by virtue of ECG findings and these patients were immediately brought to the right facility instead of just the closest or less busy ER.

Learning to do a STEMI bypass by reading a 12 lead strip is not brain surgery. Based on success with the trials here, many other services are starting to teach this skill to their medics, both ALS and BLS. I see a time soon when it will be come as common as testing blood glucose is on a reduced LOC patient.

[Dustdevil]

Actually the 12 leads don't consume any time worth arguing over.

Neither does Paramedic school. So what's stopping you?

[nsmedic393]

A Logistic comment: TO door for balloon angiography is not a serious "REALITY BASED" concept in rural Alberta, northern Ontario, rural BC or damn near anywhere other than high density populations .......whereas Throbolytics are very viable option to advance Paramedicine, internationally and perhaps positively influence MANY lives. That said many many rural ALS services do not have Throbolytics on the cars let alone ALS providers, and in some cases even with Paramedics that are very capable, their GPs/ Medical Directors will not even consider this option .... well just YET. Some provinces are much closer than others in passing. If you are from AB and reading this PLEASE review the provincial Stroke protocol on the ACP website, just might be a good idea.

Yet on the other side of the WORLD the voice of true reason and hopefully the future in the "COLONIES" the studies done in the UK are "bloody brilliant" WE in north America are so arrogant to believe that we are superior..... I am personally hold my head in shame !

CHEERS: Andy show us the way !

tniugs...

Once again you have beat me to the punch...and in a far more elegant fashion than i would have done. I sat here reading this thread with steam coming out of my ears getting ready to let loose with both barrels....

While i realise that basic training/education is not standard...here is what we have going on here in NOS.

PCP aka. basics do perform 12 leads, they should (and i say should) be able to interpret that same 12 lead without reading ***ACUTE MI***

The benefits??? Angioplasty is not a option in 99% of NS as there is only one catha lab in the province...Like tniugs pointed out though...thrombolysis is a option available in every little back woods hospital let alone a regional hospital or tertiary hospital.

Sorry dust, i don't agree with the whole loose ten minutes to gain five. We have all agreed that to some degree there is only so much a basic can do for a patient suffering from a acute MI right??? well how about this...instead of the basic sitting on his thumb for the ride into the hospital, they do a 12 lead, interpret it, fax it to the receiving hospital, call the receiving hospital...not to ask for direction but to give a verbal report on the patients condition and history so the doctor has the full picture...then they complete the provincial pre-thrombolysis checklist so upon arriving at the hospital for all intents and purposes the physician can immediately administer thrombolytics.

The basis on our treatment of Stems has been to reduce the "call to needle time" and given the fact that we are in the process of rolling out with pre-hospital thrombolysis i think the debate is mute anyways. It all decreases the amount of time the patient spend infarcting before receiving possibly definitive care.

[Dustdevil]

well how about this...instead of the basic sitting on his thumb for the ride into the hospital, they do a 12 lead, interpret it, fax it to the receiving hospital, call the receiving hospital...not to ask for direction but to give a verbal report on the patients condition and history so the doctor has the full picture...

How about this... instead of using 12-leads in the hands of uneducated providers as an excuse to not provide paramedics, just send those providers to paramedic school?

It is my belief that this is exactly what is going on. And how many people suffer and/or die due to the lack of advanced care, compared to the number of people who go straight to a cath lab instead of first to the local ER? You can't just look at those MI numbers alone. You have to put then into a big-picture perspective.

[nsmedic393]

How about this... instead of using 12-leads in the hands of uneducated providers as an excuse to not provide paramedics, just send those providers to paramedic school?

It is my belief that this is exactly what is going on. And how many people suffer and/or die due to the lack of advanced care, compared to the number of people who go straight to a cath lab instead of first to the local ER? You can't just look at those MI numbers alone. You have to put then into a big-picture perspective.

I completely agree...if that be the case then it would be well worth investing training more ALS than trying to upgrade BLS.

I hate to get onto the whole "this is what we do here" thing...but i speak to what i know.

In most areas of the province we have enough ALS. If one truck is not ALS than there is usually one close by. So i guess i was speaking to the MI numbers alone because the situation you portrayed is not happening here.

100% agree though...ALS problems need to be fixed first before trying to baindaid the problem by buying more toys.

[chevy]

Neither does Paramedic school. So what's stopping you?

I thought the title PCP would give it away. The second "p" is for Paramedic for which I competed for 50 seats against 1000 people and worked my glands off for 2 years fulltime. I will not mention the 6.5 years of university I had before that. You think you are the only one with book-learn'n here? If you are going to make snarky remarks, at least get your facts right beforehand.

Chevy. B.Sc., Paramedic

[Dustdevil]

I thought the title PCP would give it away. The second "p" is for Paramedic...

Real convenient how you sneaked past that first "p", like we wouldn't notice. You're playing semantic games. You know what I meant. I am not ignorant of Canadian EMS education. But I will admit that I thought you were in Alberta, and not Ontario. I got confused by Squint's "EMT doesn't equal PCP" rant. Sorry about that.

But you also sneaked past my question. What keeps you from going to ACP school?