# EMTs doing Cardiac Monitoring???



## Zredmond (Aug 10, 2015)

I recently talked to an EMT in NV who was fluent in cardiac monitoring. Obviously a very useful skill to have, but how common is this? I know hospitals in my area require ED techs to have certification. I really am interested in learning more about monitoring.


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## Mufasa556 (Aug 10, 2015)

What do you mean by fluent in cardiac monitoring? 

Are you talking about an ACLS class or ekg tech course?


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## Zredmond (Aug 10, 2015)

Mufasa556 said:


> What do you mean by fluent in cardiac monitoring?
> 
> Are you talking about an ACLS class or ekg tech course?


12 leads and yeah, EKG tech course.


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## Tigger (Aug 10, 2015)

Most of our EMTs go through a basic EKG course here. It's three days long and covers rhythm identification and the basics of 12 leads. It's more just to help the EMTs learn, it does not change when the paramedic attends calls and when he/she doesn't. I put lots of patients on the monitor for my own education, but if there was any question of cardiac compromise it's an ALS call. 

We are also supposed to use the monitor for "rate monitoring" if that's what's listed on the transfer PCS.


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## Brandon O (Aug 10, 2015)

This has become a bit of a hobby for some, so it might have nothing to do with their position.


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## climberslacker (Aug 11, 2015)

Brandon (and others),

That brings up a question I've had. I know you are very into 12-leads but are certified as a basic. Do you ever put the patient on the monitor (even just a 3-lead) even if interpreting is outside of your scope? I've heard of people printing rhythm strips to hand off to the MD (or DO) with transfer of care but is there any chance of getting in trouble as moniters are not technically "in scope"?


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## Brandon O (Aug 11, 2015)

Er... never really been an issue as I've never carried a monitor on a BLS unit. I realize there are places where they do (to transmit or whatever), but I imagine in those places they have protocols for this sort of thing (e.g. when a Basic can/should record an ECG and what they should do with it).


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## Clare (Aug 12, 2015)

All emergency ambulances have either a Lifepak 15 or an older MRx (being replaced with 15s).

All levels including Emergency Medical Assistant can acquire 12 lead ECGs.  

Three lead interpretation is taught to EMTs, 12 lead to Paramedic and ICP.  In essence however, 12 lead interpretation is permitted at all levels, if you want to learn it, then you can use it. For EMTs working without a Paramedic or ICP they can transmit 12 lead ECGs to a CSO on Clinical Desk for advice.


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## Jason (Aug 12, 2015)

In VA ... Cardiac Monitoring, as interpretation and applying the information toward patient care - is an ALS skill (paramedics and intermediates).  Doing 12-Leads is a BLS skill.  There is a big push to have EMTs do 12-Leads as needed.  There is also a statewide push to educate all EMTs to interpret STEMIs on a 12-Lead.  I haven't seen nor heard much in VA about EMTs going to Cardiac Monitoring here.  
Also, my OMD wants all patients that are on cardiac monitor (monitoring), to stay on the monitor while coming into the ER.  I don't believe (but not positive) that this also applies to EMTs and the 12-Lead only.


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## EpiEMS (Aug 12, 2015)

Jason said:


> There is also a statewide push to educate all EMTs to interpret STEMIs on a 12-Lead.  I haven't seen nor heard much in VA about EMTs going to Cardiac Monitoring here.



Totally agree that running a 12-lead is an EMT-appropriate skill. Curious what you mean by interpret STEMIs -- do you mean, say, call a STEMI alert if the computer interprets the 12-lead as a STEMI?


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## Jason (Aug 13, 2015)

EpiEMS said:


> Totally agree that running a 12-lead is an EMT-appropriate skill. Curious what you mean by interpret STEMIs -- do you mean, say, call a STEMI alert if the computer interprets the 12-lead as a STEMI?


EpiEMS - 
Currently, interpretation is done by ALS providers.  And by interpretation, I mean the provider's answer not the computer generated one.  
EMTs are being taught to see the STEMI on their own, not just what the monitor/computer says.  For now most places in VA ask EMTs to do the 12-Lead and trust the monitor interpretation.  It's still an ongoing educational project.  
Either EMTs or Medics can call a STEMI Alert.


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## chaz90 (Aug 13, 2015)

Hmm. Paramedic accuracy in STEMI interpretation has been frequently questioned and varies in accuracy by service (and more importantly, by provider), so I'm curious to see what the EMT STEMI activations will be like. 

Massive LAD occlusions with tombstones and reciprocal changes are easy...We tend to miss the more subtle stuff more frequently than we care to admit though along with a fair number of false positives from STEMI mimics.


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## Jason (Aug 13, 2015)

Overall, I have to agree.  More and more education and review has certainly been helpful here (for medics).  I too am interested in how the EMT STEMI activation will go ... how many true and how many false.  Over the past year or two, we have really cut down the number of false STEMI activiations with more education and review.  
There is a campaign, statewide, to educate EMTs (and review for medics) to identify STEMIs ... using a pattern recongnition type of teaching.  The results so far seem very promising.  I still think this is not gonna be a 100% catch for STEMIs, as some patients may slip through.  Patients with abnormal EKGs and providers with less experience.  
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In addition to the STEMI, 12-Lead education.  I'm hearing a push for better, more education on Stroke recognition and treatment.  I hear my field protocols may be changing some on that front.  I guess I'll see when my new protocols come out.


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## EpiEMS (Aug 13, 2015)

Jason said:


> EMTs are being taught to see the STEMI on their own, not just what the monitor/computer says.  For now most places in VA ask EMTs to do the 12-Lead and trust the monitor interpretation.  It's still an ongoing educational project.
> Either EMTs or Medics can call a STEMI Alert.



Very curious to see how that works out -- evidence is pretty good regarding medics accurately identifying STEMIs, but I would be wary of, say, somebody like  myself interpreting an ECG. Curious if there's any evidence on monitor interpretation efficacy, anybody aware of any?


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