More important IV or 12 Lead?

[ALERT Medic]

Thanks Dust. I needed a break. Good to see ya. Hopefully my time here will be better this time.

[Ridryder 911]

Okay, maybe I am missing something. What is the rush? How long does it to establish an IV and a XII lead? 1-2 minutes ? Sure, if you have a true AMI that the only thing that will save them is cath and PTCA... However most chest pains, I am in EMS to stabilize, which includes performing in a calm manner (remember, we need to attempt to lower the patients level of stress not increase) performing in a quality manner.

I believe we are loosing the point of our existence, to stabilize for transport, not treat while transporting. I attempt line before going, it is much easier on the patient stress level and me as well. Yes, I can hit a moving target but then why when it is not necessary. As well, for those that do not understand the need for prior IV establishment must not have much experience of patient's experiencing arrhythmias, chest pain and nausea.

I am by far not condoning playing around, but I have seen so many EMS go into load and go mode, that no treatment was really provided, no assessment was actually made other than a simplified ECG and a set of VS.

R/r 911

[katbemeEMT-B]

I don't think it's a matter of if one is more important than the other. I feel they are equally important. We run with a medic and emt on every rig. As an emt it is my job to assist the medic. In this case the medic would be starting an IV while I set up for the 12 lead. As soon as I am finished setting up the lead I assume the position of driver. The medic will then tell me to stop the rig for a few moments so he/she can get a reading. We then continue to the hospital with the pt IV ready and the 12 lead then. Although it seems this would delay pt care it only takes a moment for these things to be done. If the pt is critical we will pull an on-scene officer or rescue personal (depending on who is present) to drive while we both attend to the pt.

[ALERT Medic]

Okay, maybe I am missing something. What is the rush? How long does it to establish an IV and a XII lead? 1-2 minutes ? Sure, if you have a true AMI that the only thing that will save them is cath and PTCA... However most chest pains, I am in EMS to stabilize, which includes performing in a calm manner (remember, we need to attempt to lower the patients level of stress not increase) performing in a quality manner.

I believe we are loosing the point of our existence, to stabilize for transport, not treat while transporting. I attempt line before going, it is much easier on the patient stress level and me as well. Yes, I can hit a moving target but then why when it is not necessary. As well, for those that do not understand the need for prior IV establishment must not have much experience of patient's experiencing arrhythmias, chest pain and nausea.

I am by far not condoning playing around, but I have seen so many EMS go into load and go mode, that no treatment was really provided, no assessment was actually made other than a simplified ECG and a set of VS.

R/r 911

Well, I don't know about the rest of the folks on here but I for one act in a calm manner and stabilize during transport too. I guess I'm confused where your comments are directed, that's all. I certainly don't load and go with every patient.

I'll tell you how I run a typical call; I approach the patient, do an exam and initiate any immediately urgent treatment and do my diagnostic skills on the scene (in a calm manner) and load my patient for transport. Once in the unit, I explain to them what I need to do and start working while I'm moving down the road. Call the hospital, reassess during transport and obtain information. That's about it in a nut shell.

I'm not getting defensive in any manner but I've seen too many good paramedics waste time on a scene when they can do most if not all of their treatments while transporting.

Everyone has their own way of doing something and that's what makes us all unique but I don't think it's fair to label someone who perfers to treat while transporting as a 'load and go medic.'

[Medic26]

I agree it is preference, but that being siad a 12-lead is usually done first then an IV enroute or on scene depending on transport time for that particular patient as sometimes we are 20-30+ minutes out. But I will usually perform needed treatments before going enroute regardless of transport time, as in CPAP or medications. I beleive the patients in most cases benefit more from us giveng them the treatments they need rather them having to wait for a 3 minute transport with 5 minute patient care transfer time then another 20-30 minutes before a ER Doc see's them. Each case has to be wieghed out.

I also agree with the previous comment that an IV is not a treatment, most of our patients only get IV's "in case" we need to administer a "IV medication treatment". I am willing to perform a 12-lead first and IV second on 99% of my patients, but I was trained under the guideline of 12-lead within 3 minutes of patient contact for chest pain, etc.

[scottymedic]

Here in NZ, our procedures state that obtain IV access is a priority before 12 lead acquisition. However, 12 Lead is not routinly done here (only A/P's) have the training for 12 lead at the current moment in my area. As said previously by other posters, get the line in now cause when they code, there aint gonna be the time or ability with some patients.

Personal note, pleased I read the thread properlly lol, i thought the initial topic was 4 (IV) lead as opposed to 12 (XII) lead lol. Not enough coffeee.

Scotty

[iMac]

I think in the wrong position to answer this since where I'm at EMT's cannot do 12 leads, having said that wouldnt it be patient dependent?? How can you make a general statement as to which is more important where every pt is different. Either way with the training I have putting my pt on the monitor doesnt really do much for me since I can't give any cardiac drugs. other than O2 but at that point I dont need the monitor to decide whether or not I want my pt on O2.

I would say with my training that it would depend on the pt. Some I would want a line first where as others it's as important for the time being and a monitor might be a better option.

[spenac]

As to which first would agree patient dependant. As to doing 12 lead then IV while rolling, I got to say that is some of the left over golden hour idea attitude, a subject recently discussed. Being so far out we spend time on scene doing as much for the patient w/o fighting the bouncing ambulance. It's safer for the medic and the patient as both can be properly secured. Then enroute we just monitor and administer the next dose of meds ivp if needed. Can I do it bouncing down the road? Yes, but why. Why risk a missed IV or getting stuck with the dirty needle when your driver hits a rough spot. Why risk being thrown across your patient. I'm not so macho as to think someone is less of a medic because they stop and use common sense. I say do what you can on scene for safety sakes, my safety comes before anyones. Are there times I still end up doing things going down the bouncy road, yes but I limit how often.

[CBEMT]

This lays out an argument for 2 medics on a truck. 1 can start the IV while the other does the 12 lead.

12-lead isn't some mystical art. CNAs do it every day. Give me enough time and I could teach my dog how to place 12-lead stickers. If you're looking for justifications for 2 medics, even I'm willing to give you that there's far better ones than that.

[AnthonyM83]

Yup, the placing of 12-leads is definitely a BLS skill. The only difficult part is maneuvering through the saggy boobies without feeling too awkward.