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

[fiznat]

could that first EKG, the soonest one prove important?

Not really if it is just a rhythm strip (IE not a 12 lead). The 3 lead stuff (I, II, aVF) is just for rate, rhythm, and regularity. You need a 12 to look at the ischemia/infarct/injury stuff where early ECGs might play some role.

That whole "we were expected to have the patient already on the monitor" prior to ALS arrival is BS. You should tell anyone insisting you do that to piss off. It is out of your scope and they are being lazy.

I agree with everything DocHarris said as well...

[Arctickat]

What Im pondering is, would it be benneficial for BLS to conduct monitoring?

Simple answer is YES!!!!!!!!!!!!!!!!!

Here is a true story. BLS crew is the only unit available to respond to a client complaining of repeated episodes weakness and dizziness for several days but getting worse. They arrive to a 69 yr old male with a heart rate of 28 and a BP of 98/54. Slap the LP10 onto him and run off a few seconds of lead II. They had no idea what it was, but kept it for the doc, turns out it was a 3rd degree block. 30 seconds later, patient was fine, ECG was NSR, BP normal. The patient was seen at the local hospital and sent to a tertiary facility for pacemaker insertion because of a transient 3rd degree block based solely on the strip taken by the BLS crew.

[TDP]

OP was abit antagonistic, but I think this is a valid question. Let me put my spin on it.

Reasons for removal:

1. If you have a symptomatic 50 year old male, with a normal 12-lead, you still treat the symptoms. So a negative 12 lead does not stop or start the care that was provided prior to the introduction of 12 leads.

2. It was thought that field 12 leads would quicken the treatment in the ER. Most credible ERs have their own door to needle time parameters, that occur regardless of what a prehospital 12 lead shows, and regardless of whether or not the patient comes in by ambulance. Even in the presence of a positive EMS 12 Lead, the ER will still do their own 12 lead prior to beginning treatment. You could make the arguement that a positive EMS 12 lead may make the ER staff move a bit faster, but how many minutes are actually saved ? At the ERs I usually transport to, they must complete a 12 lead within 5-10 minutes of the patients arrival. My heads-up, may mean that the 12 lead machine is in the patient's room and not in the hall. I realize your anectdotal experience may be different.

3. The technology is expensive, and with what i perceive to be little return, I ask if those thousands of dollars would be better spent on capnography, CPAP, salaries, or benefits ?

4. I dont want to speak for everyone, but i dont know that i can claim a 12lead has saved the life of any of my patients, whereas, i know that CPAP has.

My arguements for keeping the technology:

1. It does help you identify the asymptomatic (i just feel weak or sick, or i have right arm pain) patient or the unusual symptomatic patient (26 year old with chest pain -- or female in her 30s), that you might have missed. But this is a small percentage of cardiac patients.

2. If you live in a rural area, based on a positive 12 lead, you may decide to transport the patient to the more distant hospital that performs CABG, versus the local hospital that can only do thrombos. Then again, if you live in a rural area, you may not have the EMS resources to have your ALS ambulance out of county for 2-3 hours.

What are your thoughts ?

more funding for emergency medical services,more education for people in the industry, i know good idea eh?

[spenac]

Ok so heres something Ive been pondering in recent times. While learning the equipment in my new fire department... I noticed our BLS ambulance has an old Phillips monitor that we use for our pulse OX and as an SAED. We can not perform cardiac monitoring as EMT-Bs in a diagnostic sense, but the monitor is capable of cardiac monitoring no less.

What Im pondering is, would it be benneficial for BLS to conduct monitoring? I dont mean determin what kind of rythm the patient has, just simply hook 'em up and thats it. For instance you get dispatched to a chest pain call... no medic available and your 15 min out from the nearest hospital. Would it help the hospital to have a print out of an EKG taken on scene (for comparison)? Would it help the medic when and if they become available? Granted both the hospital and medic will take their own more than likley, could that first EKG, the soonest one prove important? Other than this I would say continue BLS care by your local protocols.

Not trying to toot my own horn, sorry if I come off as a bit arrogant but its not difficult to hook up a monitor. I can remember many a time my BLS rig would have the medics gear on board (from a previous or for the next shift) and if I ever called for an ALS intercept Id be expected to have the monitor hooked up before we even met. And more often than not even working ALS, my medic partner would have me hooking up the monitor.

I realize there can be factors where a reading may be wrong and adjustments may have to be made. But it could be something anyone can learn. Medical Assistants, CNAs and EMT-Bs in clinical settings can all be taught this skill.

I work for a system part time that we could use the EKG and print a strip as basics, heck even as first responders. But we were 90 miles or more out to the nearest hospital and I was the highest level that patient would see till the hospital. We were taught to identify a few things but primarily it was just to help us monitor patients rate and regularity rather than to make any medical decisions. As to hospital some docs looked at our strip some didn't. Some docs and nurses tried the its out of your scope of practice so I'm reporting you and I had to go get my protocol book and show them I had written orders to do it. Really if you are within 30 minutes of the hospital I feel you are just doing a monkey skill that does not benefit anyone. Even with the distance I had for the most part thats all we were doing.

So my vote is no real benefit. Sorry. I guess it could have placebo effect on patient making them think you actually know what you are doing.

[crotchitymedic1986]

But you miss a key point regarding 12Lead and Stemi -- 12 Lead changes may not show up for up to 36 hours after an MI, so why not transport all chest pain patients (symptomatic and of reasonable age) to Cath facitlites, ditch the cost of 12Lead and put that money in medic's pockets.

[spenac]

But you miss a key point regarding 12Lead and Stemi -- 12 Lead changes may not show up for up to 36 hours after an MI, so why not transport all chest pain patients (symptomatic and of reasonable age) to Cath facitlites, ditch the cost of 12Lead and put that money in medic's pockets.

I hope you are being sarcastic. I am not a taxi driver I am a medical professional. Any that do not want to do anything but drive need to get out of my profession. Do a complete exam.

[jbanagas]

Private ems is not a profession, but a stepping stone to a bigger and better career. but I do agree 12 leads save lives, not quite as good as AEDs, but they help.

[spenac]

Private ems is not a profession, but a stepping stone to a bigger and better career. but I do agree 12 leads save lives, not quite as good as AEDs, but they help.

Why?

[WolfmanHarris]

jabangas, I'm not clear where your ignorance comes from. I feel like you should have more understanding of how these things work and why an ounce of prevention is worth more than a 4% SCA survival rate. Rapid reperfusion following AMI, identified by 12 lead pre-hospital and brought to a cath lab with minimal door to balloon time, or thrombalized in the Ambulance or ED will result is way more saved lives than the defibrillator on the Ambulance. The standard for response times (which is based on nothing, but that's another issue) is 8 minutes. Your SCA patient is dead and likely going to stay that way at that point. Early recognition and treatment of a STEMI may stop them from reaching that point, saving more lives.

Jabangas, I'm a student with no road experience and only experience on a campus first aid team and lifeguarding before this. I shouldn't really know this much more than you, should I? It's crap like this that makes any of your other opinions invalid, because you demonstrate so much ignorance on some things that on others it's hard to consider your opinion credible. If you know better and can express it please do so. If not, consider holding off on typing and learning something.

[akroeze]

I have my theory that jban is trolling in their own way. The posts are just enough to incite a response out of people.