# 12 Lead EKG?



## MMiz (Jul 3, 2004)

The company I work for has an EMS contract with a city.  Several companies bid, but we were the only ones that did 12 leads.  I'm wondering how common it is.  I know when I did my ride-along with AMR they did a 3-lead.  

It seems to be one of those things that is slowly catching on.  Our crews required a bit of extra training to do it, but it seems to really set us apart.


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## ResTech (Jul 3, 2004)

All the ALS services around here have had 12-lead capablity for some time. They're is a new program underway at one local hospital to have the paramedic's diagnose an MI in the field via set screening criteria and upon consultation with medical command, these patients will be transported direct to the cath lab versus to the ED. 

I think 12-leads are great in the field.


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## rescuecpt (Jul 4, 2004)

My ambulance corps uses 3 leads for the Critical Care EMTs and the Medics and the 80 car (first responder) have the 12 lead upgrade for the same machines.  We use the Lifepack 12's and I like them (the FD has a Zoll and it's ok too, they're just very different).


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## cbdemt (Jul 5, 2004)

Many Basics in my area are trained to do 12 lead.  I think its great considering the long transport times, and that ALS rarely makes it on scene before we take off.  We can have already have the pt hooked up when we intercept with the medics, I think they appriciate it.

EDIT: oops that was a little incoherent....


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## rescuecpt (Jul 5, 2004)

Are they trained to interpret and treat as well, or just to set up the machine for when ALS arrives?

I had a "Tylenol OD" on Saturday - a 19 yo who took an entire valu-size bottle of Tylenol.  He was playing possum to a certain extent, but I think he took his albuterol too - he was tachy at 120 but would drop by steady increments to 90, then shoot straight back to 120.  He missed 4 or 5 beats at one point and scared the petooties out of me because I was alone in the back, with a new driver up front.     

Oh, and I wasn't running ALS (haven't been "cleared" to operate on my own at the ambulance corps yet) - so all I had was a pulse ox to "monitor" his heart.

When we got to the hospital and were finally able to get an ECG, he was in sinus tach.  He started to "come around" when they threatened him with an NG tube.


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## cbdemt (Jul 5, 2004)

We are trained to recognize some basic rhythms, and have no interventions above BLS protocols.  It’s mostly to give the receiving hospital or intercepting medics a heads up.  And yes, they do like it when they climb onboard and the pt's wired and ready.


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## ffemt8978 (Jul 7, 2004)

I'd be happy if they would let us interpret 3-leads.

Our current interpretation of ECG strips is "Good" or "Bad".   :angry:


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## rescuecpt (Jul 7, 2004)

"If you don't know the rhythm, shock it till you do!"


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## ffemt8978 (Jul 8, 2004)

> _Originally posted by rescuelt_@Jul 7 2004, 08:30 PM
> * "If you don't know the rhythm, shock it till you do!" *


  :lol: 

Unfortunately, we're not even allowed to interpret the 4 basic rythyms (sinus, V-Fib, Asystole, and PEA).  :angry:


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## citizencain20 (Jul 10, 2004)

A project that is currently in the works in my jurisdiction, is the ability to send digitally the lifepac ECG reading to the recieving hospitol.  Even as a basic, the recieving facility will have a much better understanding of patient condition and allow medical direction the ability to tell the basics on the med some intervention that they may be capable of making but are not sure if it required.  And, as stated before, having a patient hooked up to a 12 lead ECG has many added benifits.


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## rescuecpt (Jul 11, 2004)

In order for a vehicle to be ALS certified in NY State it must have a monitor/defib (such as the Lifepack12) WITH telemetry capabilities, and the appropriate cell phone over which to transmit the telemetry to medical control (at the State Hospital).


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## croaker260 (Jul 23, 2004)

We all do 12 leads as medics, and all of our EMT's are taught to set up the 12 lead and apply it to free up hands. WHile soem are better at reading thena others, we have several "12 lead gurus's" in our dsepartment  that help do the referesher training.


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## rescuecpt (Jul 23, 2004)

I was just told on Tuesday that the Corps wants me to attend a 12-Lead class.  Technically as a CC it's not required (3 is good enough) but what the heck, the more the better... plus I get CME credit for it.


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## Firechic (Jul 23, 2004)

12 leads are essential to my medical director's protocols. We use LP12 with telemetry, ETCO2, SPO2 and NIBP. Jeez, I love my lifepack 12!
 :wub:


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## medicfire909 (Aug 4, 2004)

Fire Chic I also love the Life Pack 12 well until you have to carry the darn thing to the 14 floor on an 90 degree August day when the elevator stops working...lol


We are a tiered agency and we have a paid ALS crew on from 6am -6pm and 6pm -6am we are a volunteer agency. We allow EMT-B to be crew chiefs and drivers in the agency and with 1 crew chief and a driver a ambulance may leave the station. If this is the case the ALS gear is locked in a cabinet and we are also one of the few agencies in NY to carry Narcotics so we do have to meet additional guidelines for controlled substances. We also lock the the manual defibrillators in the cabinet as well. We do use a LP 5 which has the key to change from AED to manual for the basics - the benfit to that is the LP 5 and LP 12 and newer accept the same lead systems so once a patient is monitored on a LP5 they can be easily swicthed to a LP12 system once a ALS provider is available in the case of an intercept or a ALS member responds to the scene in their private vehicle. 

We do train the BLS members in the setup of the 12 lead system from point of view of assistance in how they should interact with the ALS provider and the patient while a 12 lead is being hooked up and used. I am one of those old times that remembers before EMT-Bs being allowed to defibrillate at all, and I do see one day BLS providers gaining more skills comming down from the ALS providers and maybe one day that will be 12 lead EKGs.


Julie


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## PArescueEMT (Dec 28, 2004)

> _Originally posted by medicfire909_@Aug 4 2004, 12:22 AM
> * We do use a LP 5 which has the key to change from AED to manual for the basics *


 The LP12 can also be used as an AED as well.

Erika, You said you use a 12, can you monitor A-Lines as a CC/Paramedic or is a Nurse still needed for that?

I have used the LP12CC. It is a very fun toy.
4 or 12 Lead monitoring, SpO2, ETCO2, NIBP, and A-Line Monitoring


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## rescuecpt (Dec 29, 2004)

> _Originally posted by PArescueEMT_@Dec 28 2004, 11:00 PM
> * Erika, You said you use a 12, can you monitor A-Lines as a CC/Paramedic or is a Nurse still needed for that? *


 We're allowed to, if we're trained for it.  The Corps is going to do an inservice in the next couple months for those of us not already specifically trained (myself included).


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## Jon (Dec 29, 2004)

> _Originally posted by PArescueEMT+Dec 28 2004, 11:00 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (PArescueEMT @ Dec 28 2004, 11:00 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-medicfire909_@Aug 4 2004, 12:22 AM
> * We do use a LP 5 which has the key to change from AED to manual for the basics *


The LP12 can also be used as an AED as well.

Erika, You said you use a 12, can you monitor A-Lines as a CC/Paramedic or is a Nurse still needed for that?

I have used the LP12CC. It is a very fun toy.
4 or 12 Lead monitoring, SpO2, ETCO2, NIBP, and A-Line Monitoring [/b][/quote]
 PArescueEMT, this is our continuing argument. I like the Zoll's myself for Critical Care / working a code in hospital, but the 12 is truly an EMS monitor, and, espicially with the 2 batteries vs. 1 is a much better field monitor, but both can do everything but actually wash the dishes  :lol:     :lol: 

RescueCpt

So CC is better than P???



Oh, and one squad out my way is using the new phillips, as it can be locked with a keycode to be BLS-only AED, or unlocked and do 12 leads (i think)

12 leads are a valuable diagnostic tool, but A you need to know how to read them, and B you need to pass them on to the doc to read.


Jon


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## rescuecpt (Dec 29, 2004)

No, CC and P are the same except for 3 things:

1. P's get paid more
2. P's are in school longer
3. P's can do a needle crych (sp?) CC's cant... YET.

Otherwise everything is the same, P's have a few more standing orders but in the end we have the same skills and the same overall orders.


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## coloradoemt (Feb 10, 2005)

We run with the LP 12's. Usually hook up 4 leads. As an EMT I can hook the patient up if I have requested ALS and they are not 20 minutes out!!  :lol:


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## PArescueEMT (Feb 11, 2005)

> _Originally posted by rescuecpt_@Dec 29 2004, 08:08 PM
> * No, CC and P are the same except for 3 things:
> 
> 1. P's get paid more
> ...


 So... basically... you're a Jersey medic?


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## medic03 (Mar 6, 2005)

> _Originally posted by rescuecpt_@Dec 29 2004, 07:08 PM
> * No, CC and P are the same except for 3 things:
> 
> 1. P's get paid more
> ...


 Erika, I'm going to kick your *** for that statement. I just read it and you are in sooooooo much trouble   <_<


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## rescuecpt (Mar 6, 2005)

> _Originally posted by medic03_@Mar 6 2005, 04:39 AM
> * Erika, I'm going to kick your *** for that statement. I just read it and you are in sooooooo much trouble   <_< *


 Ok, YOU can do a few more things, but the vollie medics I ride with can't... 

And I have noted in other places how much HARDER you guys work in school and here I noted how much LONGER you spend in school.

Oh, I did forget to mention though that you are so much smarter than any CC I have ever met, myself included, and that I cry myself to sleep at night because I'm not you.


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## shorthairedpunk (Mar 6, 2005)

We run 12 leads, its frustrating because we are only trained in interpretation as far as reading what the algorythyum says is happenning. But the LP12s we use are known for reliable interpretations and in the field, spending much more time trying to further interpret on your own is a wate of time for the majority. We can treat based on what the LP12 says. Our Basics are trained to det them up. We have telemetry in the works, but we have to get the hospital to get heir end up and running before we purchase the transmitters.

On the agenda for the BLS units is 12 lead capability if their is time before we intercept with them. LP12s or Zolls are required for any transporting agency in the system, the BLS units will be locked into AED mode though, unless they have the monitor going. They wont have any manual capabilities


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## Doctor B (May 27, 2005)

We have been utilizing 12-lead EKG's in our EMS system for about 15 years now and at first they even let us trial the use of some anti-thrombolytics but in the end with there seemingly being a cath lab sprouting up everywhere around us we aren't carrying the pharmacologics anymore. Our protocol is as follows: Any hemodynamically stable patient c/o chest pain that's cardiac in nature (no, the chest vs. steering wheel MVC doesn't count) gets a 12-lead. If transport time is longer than 10 minutes on the unstable patient and everything else is done a 12-lead can be performed en route to the hospital. We then fax the 12-lead via cell phone to the ER for a heads-up so they can ready the cath lab. 

Regarding the interpretation of the 12-lead. Here's my personal spin on it And this is what I teach as well. If you can just learn to recognize the presence of ST segment elevation in the contiguous leads that should get you a good start. As far as knowing what MI is occurring where I use the acronym ISAL which stands for the 4 different major AMI's. I (Inferior) S (Septal) A (Anterior) L (Lateral)
The reason I put it in that order is for ease of interpretation of the 12-lead as you are reading it left to right.

It works like this.

I = ST elevation in Leads II, III, and AVF

S = ST elevation in V1 & V2

A = ST elevation in V3 & V4

L = ST elevation in V5 & V6

And that's it. 
Until the EMS Medical directors actually decide to write specific protocols based on the type of Infarction the patient is experiencing I don't believe we should have to be super concerned about it either. Just my .02 worth.


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## Jon (May 27, 2005)

Awsome. I just started at my clinical site, which is just starting to play with 12 leads (telemetry tranmission is on the horizon). 12 lead class was over a year ago, and I've been being babied by the MAC5000's in the ED...

Jon


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## Jon (May 27, 2005)

> _Originally posted by Doctor B_@May 27 2005, 12:15 PM
> * We have been utilizing 12-lead EKG's in our EMS system for about 15 years now and at first they even let us trial the use of some anti-thrombolytics but in the end with there seemingly being a cath lab sprouting up everywhere around us we aren't carrying the pharmacologics anymore. Our protocol is as follows: Any hemodynamically stable patient c/o chest pain that's cardiac in nature (no, the chest vs. steering wheel MVC doesn't count) *


 I dissagree...

How can you be certain they aren't having a massive MI either before the accident, or as result of stress and anxiety related to the accident?

A great medic once told me to never rule out chest pain, just because they were in an accident. Too often we look for simple excuse for our problems.

Jon

~ P.S. I'm not attacking you, just illistrating a different point of view.


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## ffemt8978 (May 27, 2005)

> _Originally posted by MedicStudentJon+May 27 2005, 09:47 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (MedicStudentJon @ May 27 2005, 09:47 AM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-Doctor B_@May 27 2005, 12:15 PM
> * We have been utilizing 12-lead EKG's in our EMS system for about 15 years now and at first they even let us trial the use of some anti-thrombolytics but in the end with there seemingly being a cath lab sprouting up everywhere around us we aren't carrying the pharmacologics anymore. Our protocol is as follows: Any hemodynamically stable patient c/o chest pain that's cardiac in nature (no, the chest vs. steering wheel MVC doesn't count) *


I dissagree...

How can you be certain they aren't having a massive MI either before the accident, or as result of stress and anxiety related to the accident?

A great medic once told me to never rule out chest pain, just because they were in an accident. Too often we look for simple excuse for our problems.

Jon

~ P.S. I'm not attacking you, just illistrating a different point of view. [/b][/quote]
 Very true, but our protocols specifically state we don't work a "trauma code".  We're allowed to do CPR on them and that's it.


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## Jon (May 27, 2005)

> _Originally posted by ffemt8978+May 27 2005, 12:49 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (ffemt8978 @ May 27 2005, 12:49 PM)</td></tr><tr><td id='QUOTE'>
> 
> 
> 
> ...


Very true, but our protocols specifically state we don't work a "trauma code".  We're allowed to do CPR on them and that's it.    [/b][/quote]
 Not saying code... just talking about the 35 or 40 y/o male who just wrapped his sports car around a tree who wasn't wearing a seatbelt.

And using Chest Pain as a nature to get the medic to come out and play means no one says you are a wimp for not grounding the guy to the local ED... 

Jon


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## ffemt8978 (May 27, 2005)

But the problem I'm seeing with our newer EMT's is that they won't treat the chest pain as cardiac in nature, or if the patient has coded, work him up because of the misunderstanding they have about the protocols.


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## Jon (May 27, 2005)

> _Originally posted by ffemt8978_@May 27 2005, 12:57 PM
> * But the problem I'm seeing with our newer EMT's is that they won't treat the chest pain as cardiac in nature, or if the patient has coded, work him up because of the misunderstanding they have about the protocols. *


 Are you saying they won't call ALS for Chest Pain + MVC

And / or

Are you saying they will work the trauma code?


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## ffemt8978 (May 27, 2005)

> _Originally posted by MedicStudentJon+May 27 2005, 09:59 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (MedicStudentJon @ May 27 2005, 09:59 AM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-ffemt8978_@May 27 2005, 12:57 PM
> * But the problem I'm seeing with our newer EMT's is that they won't treat the chest pain as cardiac in nature, or if the patient has coded, work him up because of the misunderstanding they have about the protocols. *


Are you saying they won't call ALS for Chest Pain + MVC

And / or

Are you saying they will work the trauma code? [/b][/quote]
 Yes, they won't call

and/or

No, they won't work it.


I did a scenario a few months back.  I gave them a 45yoM, single vehicle MVA at low speeds with no intrusion or significant damage to the vehicle.  Pt. was unresponsive and not breathing with no signs of injury.  They looked at me and said, "We don't do trauma codes." and refused to work him.


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## Jon (May 27, 2005)

> _Originally posted by ffemt8978+May 27 2005, 02:17 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (ffemt8978 @ May 27 2005, 02:17 PM)</td></tr><tr><td id='QUOTE'>
> 
> 
> 
> ...


Yes, they won't call

and/or

No, they won't work it.


I did a scenario a few months back.  I gave them a 45yoM, single vehicle MVA at low speeds with no intrusion or significant damage to the vehicle.  Pt. was unresponsive and not breathing with no signs of injury.  They looked at me and said, "We don't do trauma codes." and refused to work him. [/b][/quote]
 Ahhh.

My personal feeling is that if you even suspect the code wasn't caused by tramatic injury, you work them until command says otherwise. What is the worst that could happen? Yu get practice working a code, get a tube, etc, and then have the doc call it. Not a WHOLE TOTAL LOSS!

I'm seeing things like a student, aren't I????


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## Jon (May 27, 2005)

We had one in my area a while back.

Guy driving down highway with his wife. He starts complaining of chest pain, passes out, drives across the median, strikes a tractor-trailer, tractor trailer looses contro, runs up an embankment and flips back onto the highway. Driver DOA, passenger flown to trauma Center (think she survived, not 100% sure), tractor trailer extrication took 2+ hours. Hazmat playing with driver's cargo for HOURS, road closed for a day.

Jon


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## rescuecpt (May 27, 2005)

> _Originally posted by MedicStudentJon_@May 27 2005, 01:29 PM
> * We had one in my area a while back.
> 
> Guy driving down highway with his wife. He starts complaining of chest pain, passes out, drives across the median, strikes a tractor-trailer, tractor trailer looses contro, runs up an embankment and flips back onto the highway. Driver DOA, passenger flown to trauma Center (think she survived, not 100% sure), tractor trailer extrication took 2+ hours. Hazmat playing with driver's cargo for HOURS, road closed for a day.
> ...


 We had a firefighter of ours have a heart attack and drive off a cliff down the street from the firehouse.  His granddaughter got out with just scratches, his wife was DOA, and he was so badly injured he was unrecognizable.  They waited to bury his wife for 3 weeks so that they could be buried together.  Amazingly, he has made a full recovery.


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## ECC (May 27, 2005)

> _Originally posted by medicfire909_@Aug 3 2004, 11:22 PM
> * We do use a LP 5 which has the key to change from AED to manual for the basics *


 I have never seen a LP 5 that could be set up for that...There is no software on that machine...it is a simple crt and a monitor. IIFC  :huh:


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## ECC (May 27, 2005)

> _Originally posted by medicfire909+Aug 3 2004, 11:22 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (medicfire909 @ Aug 3 2004, 11:22 PM)</td></tr><tr><td id='QUOTE'> We do use a LP 5 which has the key to change from AED to manual for the basics [/b]_


_
I have never seen a LP 5 that could be set up for that...There is no software on that machine...it is a simple crt and a monitor. IIFC  :huh:

<!--QuoteBegin-rescuecpt_
*No, CC and P are the same except for 3 things:

1. P's get paid more
2. P's are in school longer
3. P's can do a needle crych (sp?) CC's cant... YET.

Otherwise everything is the same, P's have a few more standing orders but in the end we have the same skills and the same overall orders. *[/quote]

I am not feeling the love here Erika... <_< 

Did Medic03 throw you a beatin for this?!?!?   

PS it is needle cric (as in Cricothyroidotomy) and do not forget we can do Needle Decompression...it was w/o a 34 when I was there.

They didn't change the ALS protocols did they? EMT-P's standings were more inclusive than the A3's IIRC...but that was a loooooooooooow blow miss! <_< 

They really need to allow the poster to edit the post indefinately here!


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## rescuecpt (May 27, 2005)

> *PS it is needle cric (as in Cricothyroidotomy) and do not forget we can do Needle Decompression...it was w/o a 34 when I was there.
> 
> They didn't change the ALS protocols did they? EMT-P's standings were more inclusive than the A3's IIRC...but that was a loooooooooooow blow miss! *



I do not deny that CC's know what to do, while P's know WHY to do it.  That is the major distinction.

I can do needle decompression w/a 34.  They've upgraded protocols a lot.  EMT-P's have more standing orders than I do, but in theory, with a phone call, I can do pretty much everything.  Gimme your fax #, i'll fax you a copy.   :lol:


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## ECC (May 27, 2005)

I am just bustin on ya Erika...feel the love???


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## rescuecpt (May 27, 2005)

> _Originally posted by ECC_@May 27 2005, 03:58 PM
> * I am just bustin on ya Erika...feel the love??? *


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## Doctor B (May 28, 2005)

> _Originally posted by MedicStudentJon_@May 27 2005, 11:47 AM
> *
> I dissagree...
> 
> ...


 Jon,

No offense taken and I can certainly appreciate your point. The intent behind the comment was certainly not to look for the simple excuse for the problem. It is simply meant to motivate our medics to do like you imply and be more thorough in their assessment wether it be through verbal questioning or hands on. I have even had the pt. with the MI that caused the accident. I believe however that with proper questioning of the conscious trauma patient you can rule out a myriad of underlying problems. Getting into questions about their chest pain can certainly help with that. By simply asking them, " does the chest pain feel like it's on the surface or inside?" Did you have the pain before the accident,  if so does it feel the same now or is it different and how?" "Does the pain worsen with inspiration/ exhalation, or with palpation?" "Do you have pain anywhere else with it?" are just a few to start and certainly not the end all.
Obviously if the pt. is unconscious the questioning goes out the window and you need to rely on other tools (i.e. EKG changes; irregularity, T-wave progression, ST elevation in Lead II, even though it only can show the possibility of an Inferior Wall MI) most times unless your transport times are long the 12-lead falls down low on the priority list of an unconscious trauma victim. 
Like you stated, it is definitely the great medics that can make the differential diagnoses CORRECTLY and not take the easy way out. My philosophy is and has always been, BE AGGRESSIVE, for it's better to be in front of the 8 ball than behind it. All my patients are treated like they are a member of my family because that is what I would expect if I or a loved one were to ever need emergency medical services. 

Great point Jon. 

Thanks


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## ECC (Jun 1, 2005)

Doctor B is right...try to stay inhead of the 8-ball...it is awfully hard to get back there once you let it in front of you!


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## medic03 (Jun 2, 2005)

> _Originally posted by ECC_@Jun 1 2005, 02:37 PM
> * Doctor B is right...try to stay inhead of the 8-ball...it is awfully hard to get back there once you let it in front of you! *


 wait, are we talking about EMS or shooting pool... I'm confused....  :lol:


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## medic03 (Jun 2, 2005)

> _Originally posted by ECC_@May 27 2005, 03:13 PM
> *
> 
> Did Medic03 throw you a beatin for this?!?!?
> ...


 Oh, I have... I have.  
Erika, no offence to you guys in nY who are CC's, but you just don't get enough training.  You hit the nail on the head when you say that  "I do not deny that CC's know what to do, while P's know WHY to do it. That is the major distinction."   
That is a HUGE distinction.  Any monkey can pop an iv in or tube, it's understanding what is going on with the pt and why you are doing something that is very critical in the care for the pt.   Any pt with AMS in NYC can get d50, thiamine and narcan standing orders, no questions asked.  The trick is to find out why the pt has AMS and treat that problem, not use a blanket policy and give the d50 and narcan. A good history and understanding your meds and what they do will help treat your pt better, insted of playing chemist and loading them all up on every drug that a person can give under standing orders.  I'm not attacking you or saying you suck (you know I love ya) I'm just saying that I feel that the cc's in the county do not get enough training and are thrown to the wolves. You either sink or swim and that it's. I don't think it;s fair that they put you in class 2X a week and expect you to have the same knowledge as the medics and docs when you call medical control or bring a pt into the hospitals.  Thee are some great CC's out there, but the majority of them stop learning after they get out of class. The other big diffrence is that the majority of CC's are doing this as a volly thing at their local FD or Ambulance corp, where there are ony a handful of medic that are doing this only as a volly, almost all of them are paid somewhere.  I have no idea why anyone would want to go through medic class and then just volly..... Screw that, I worked too hard to get where I am to just volly.  No offence to you at all or to any CC on these boards from NY, but  it doesn't matter if there are only a few diffrences in standing orders between the medics and CC's, it's the knowledge that's behind the training that's what's important.  I wouldn't care if they took all my standing orders away.  Now Erika, since we know eachother and a lot of the same people, would you really want some of the EMS providers we know taking care of you or your parents?  How about "Tool" from where I use to belong? Or the current student that rides with my when I work the overnights at your corp? Both nice people, but the training and lack of skill isn't there, but they both will have their ALS cards and can staet giving meds like crazy if they wanted.  
Again, I'm sorry if it seems like I'm attacking you or putting you down personally, I'm not, and if it wasn't for you guys we wouldn't have any als on Long island.  I'm just stressing the point that it's not about who can do what, when and how much they can give, it's about understanding why you are doing something and what it's going to do to the pt when you give it.


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## Ridryder911 (Jun 2, 2005)

Doctor B...

Bob Page has an excellent acroynm for the 
I S A L 

I    

See 

All

Leads 


A good way to remember..

Be safe, 
Ridrtder 911


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## rescuecpt (Jun 3, 2005)

> _Originally posted by medic03+Jun 2 2005, 07:22 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (medic03 @ Jun 2 2005, 07:22 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-ECC_@May 27 2005, 03:13 PM
> *
> 
> Did Medic03 throw you a beatin for this?!?!?
> ...


Oh, I have... I have.  
Erika, no offence to you guys in nY who are CC's, but you just don't get enough training.  You hit the nail on the head when you say that  "I do not deny that CC's know what to do, while P's know WHY to do it. That is the major distinction."   
That is a HUGE distinction.  Any monkey can pop an iv in or tube, it's understanding what is going on with the pt and why you are doing something that is very critical in the care for the pt.   Any pt with AMS in NYC can get d50, thiamine and narcan standing orders, no questions asked.  The trick is to find out why the pt has AMS and treat that problem, not use a blanket policy and give the d50 and narcan. A good history and understanding your meds and what they do will help treat your pt better, insted of playing chemist and loading them all up on every drug that a person can give under standing orders.  I'm not attacking you or saying you suck (you know I love ya) I'm just saying that I feel that the cc's in the county do not get enough training and are thrown to the wolves. You either sink or swim and that it's. I don't think it;s fair that they put you in class 2X a week and expect you to have the same knowledge as the medics and docs when you call medical control or bring a pt into the hospitals.  Thee are some great CC's out there, but the majority of them stop learning after they get out of class. The other big diffrence is that the majority of CC's are doing this as a volly thing at their local FD or Ambulance corp, where there are ony a handful of medic that are doing this only as a volly, almost all of them are paid somewhere.  I have no idea why anyone would want to go through medic class and then just volly..... Screw that, I worked too hard to get where I am to just volly.  No offence to you at all or to any CC on these boards from NY, but  it doesn't matter if there are only a few diffrences in standing orders between the medics and CC's, it's the knowledge that's behind the training that's what's important.  I wouldn't care if they took all my standing orders away.  Now Erika, since we know eachother and a lot of the same people, would you really want some of the EMS providers we know taking care of you or your parents?  How about "Tool" from where I use to belong? Or the current student that rides with my when I work the overnights at your corp? Both nice people, but the training and lack of skill isn't there, but they both will have their ALS cards and can staet giving meds like crazy if they wanted.  
Again, I'm sorry if it seems like I'm attacking you or putting you down personally, I'm not, and if it wasn't for you guys we wouldn't have any als on Long island.  I'm just stressing the point that it's not about who can do what, when and how much they can give, it's about understanding why you are doing something and what it's going to do to the pt when you give it. [/b][/quote]
 No, I totally hear you - although I will probably knee you if I'm not one of the "good CCs" you referenced...   A lot of people stop learning - but a lot of people don't.  It would be nice if there was more instruction in the CC course, but there's only so much you can cram into a "non-professional" cert - and I say that because most agencies don't pay anymore for a CC than a Basic.  You know if the pay cut wasn't so huge I'd probably be in the medic class in the fall, but I really can't make that sacrifice.  Anyways, there's a short list of people I'm calling before the ambulance if I ever need it - you, Nat, Brian, Alex...  

But you are totally right.  However, there are a lot of medics I've met who are just as bad as the two people you mentioned...  I think Con Ed requirements for CCs should be stricter - right now the only Con Ed that's required is advanced airway and anything you need to refresh.  There should be mandatory updates at least quarterly.


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## ECC (Jun 3, 2005)

> _Originally posted by rescuecpt_@Jun 3 2005, 08:13 AM
> *No, I totally hear you - although I will probably knee you if I'm not one of the "good CCs" you referenced...  A lot of people stop learning - but a lot of people don't. It would be nice if there was more instruction in the CC course, but there's only so much you can cram into a "non-professional" cert - and I say that because most agencies don't pay anymore for a CC than a Basic. You know if the pay cut wasn't so huge I'd probably be in the medic class in the fall, but I really can't make that sacrifice. Anyways, there's a short list of people I'm calling before the ambulance if I ever need it - you, Nat, Brian, Alex...
> 
> But you are totally right. However, there are a lot of medics I've met who are just as bad as the two people you mentioned... I think Con Ed requirements for CCs should be stricter - right now the only Con Ed that's required is advanced airway and anything you need to refresh. There should be mandatory updates at least quarterly.*


Boy I am glad I made the cut!

























Oh, wait...I am not on the list! :blink:


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## rescuecpt (Jun 3, 2005)

> _Originally posted by ECC+Jun 3 2005, 08:30 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (ECC @ Jun 3 2005, 08:30 AM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-rescuecpt_@Jun 3 2005, 08:13 AM
> *Anyways, there's a short list of people I'm calling before the ambulance if I ever need it - you, Nat, Brian, Alex...
> 
> *


Boy I am glad I made the cut!

Oh, wait...I am not on the list! :blink: [/b][/quote]
 C'mon Chris, you're nowhere near me.  If you were here or I was in CO, then you'd be on the list.


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## Doctor B (Jun 3, 2005)

> _Originally posted by ridryder 911_@Jun 2 2005, 08:38 PM
> * Doctor B...
> 
> Bob Page has an excellent acroynm for the
> ...


 You're exactly right! 
Bob is a great EKG instructor and has done a few classes at our department as well as for the CCEMT-P class at Loyola. I used the same acronym and just applied it to the correct myocardial walls. 
I would say to anyone who has the opportunity to attend one of Bob Page's lectures regarding EKG interpretation no matter what level you are at, DO IT! You won't be sorry.  (Oops, are we allowed to plug instructors and their classes here?) If not Mods feel free to delete. Sorry


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## DT4EMS (Jul 10, 2005)

12 leads are the standard around here too and have been for several years. I was against them at first. Once I went through the class I changed my mind. 

Like Bob Page says "There are only two types of medics, those who read 12 leads and those who will."


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