# Transmitting 12 leads



## Hockey (Feb 5, 2011)

Does your area transmit 12 leads?  They are finally really pushing that we transmit our 12 leads.  

To me, its better to just educate your Paramedics better and actually trust your medics.

I know some areas tried this out but got away from it 

Our area is usually behind the rest by about 5 years it seems :lol:


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## johnmedic (Feb 6, 2011)

*Yes.*

We transmit.

Usually the doc won't look at the 12-lead by the time we arrive.. & the first thing they'll ask for anyways is for their own 12-lead. But once in awhile when our transport times range maybe ten minutes after obtaining a good 12-lead (& it's a clear-cut MI) they'll have us wheel the pt straight through to the cath-lab. 

That's a good feeling.

Edit: We transmit off our LP-12's. They work well, for the record.


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## MasterIntubator (Feb 6, 2011)

We have been transmitting them for about 5 years now, and its been great.  There has been a couple times where I actually did a consult with the doc via phone as he was looking at the ECG, and its very reassuring to have that as a back up with that odd rhythm pops up.


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## Veneficus (Feb 6, 2011)

Hockey said:


> To me, its better to just educate your Paramedics better and actually trust your medics.



I used to think that was the solution until a cardiologist that subspecializes in electrophysiology spent about 8 hours over 2 days just listing and explaining  all the things a 12 lead shows. I can remember about 1/2 of what he said. 

The idea that somebody in cardiology is having a look for more than just ST elevation is definately a good thing.

It is not that I am against educating medics, but there are far more useful things to spend time educating them on than just electrophysiology.


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## DrParasite (Feb 6, 2011)

Veneficus said:


> I used to think that was the solution until a cardiologist that subspecializes in electrophysiology spent about 8 hours over 2 days just listing and explaining  all the things a 12 lead shows. I can remember about 1/2 of what he said.
> 
> The idea that somebody in cardiology is having a look for more than just ST elevation is definately a good thing.


While I agree with you 100%, you are getting the info from a cardiologist who specializes in electrophysiology.  our 12 leads go to the ER, where the online medical control doc can review it (if it works that day).  Do you think MedControl is actually looking for everything, especially when coupled with all their other ER responsibilities, or are they just looking for the biggies and gonna let the cardiologist review it later if needed?


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## jjesusfreak01 (Feb 6, 2011)

I would guess that in general, the MC doc is going to be looking to confirm STEMI criteria for cath lab activation, as well as diagnose any possibly fatal conduction deficits that might require pacing. Essentially, if its going to kill them quickly, they care, otherwise, its the cardiologists problem.


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## Hellsbells (Feb 6, 2011)

We transmit all suspected STEMI ECG's. If the ER doc agrees we go right to the cath lab, no stops in ER. A good standard of care in my opinion.


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## WolfmanHarris (Feb 6, 2011)

We activate the team and bypass ED on our discretion alone, but as part of the alert process the 12 lead is transmitted as an FYI for the team.

We have to transmit right to the cardiologist for the STREAM thombo trial. Since he is overseeing the trial, he does the interpretation and randomization to help control errors in the research.


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## 8jimi8 (Feb 6, 2011)

Wouldn't it be good if you were trusted to administer thrombolytics?


I know some services can.


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## WolfmanHarris (Feb 6, 2011)

8jimi8 said:


> Wouldn't it be good if you were trusted to administer thrombolytics?
> 
> 
> I know some services can.



It's a clinical trial comparing early thrombolytics with activated heparin and early PCI. I'll accept the research controls for the knowledge gained. Once best practice is established, I'm sure this like anything else would become part of our standing directives.


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## clibb (Feb 6, 2011)

We do our own 12-leads. We usually get one on scene, one on the way, and then at our arrival. Like to compare . Then the doctor will take ours and compare it to the Tele team's. 
I'm lucky to be with a Paramedic that's a freaking genius when it comes to Cardiac stuff. He teaches me a lot about it. Is currently walking me through Dubin's book.


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## MRE (Feb 7, 2011)

We don't have the technology to transmit.  Unless of course the medic got on the radio and described the waveforms to the hospital.  

"There is a little round bump, and then a spiky looking thing, then another bump..."


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## TomB (Feb 7, 2011)

We've had at least one case where the ability to transmit the ECG gave the ED physician the opportunity to pull the "old" ECG from the patient's chart and see that the inferior ST-elevation was not new. There's nothing wrong with putting another set of critical eyes on a 12-lead ECG prior to activating the cardiac cath lab or subjecting a patient to a potentially risky procedure. It's good patient care.


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## rhan101277 (Feb 7, 2011)

We transmit all ECG's regardless of the presence of ST elevation or not.  The doc reviews them before our arrival, unless he is busy.

If it is ST elevation I make it know in my report.  In some cases I may do a posterior 12 lead for cases where ST depression exist in V1-V6.


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## NomadicMedic (Feb 7, 2011)

8jimi8 said:


> Wouldn't it be good if you were trusted to administer thrombolytics?
> 
> 
> I know some services can.



Like mine. However, we must transmit our 12 lead for consultation before we administer TNKase.


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## 8jimi8 (Feb 7, 2011)

Perfectly reasonable.  and NEEDED for the AMI patients.  I'm glad that some services have their ducks in a row.


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## tazman7 (Feb 8, 2011)

We can transmit. But as someone else said as soon as you get to the ed they do their own 12 lead and dont even pay attantion to ours. 

In the two years I have been at my current place of employment, I have transmitted hundreds of 12 leads and have never once had a doctor look at it because when I give my report to the RN or Dr the first thing I always ask is if they received my inbound and my 12 lead if I sent one.

Kind of a waste if you ask me. We dont carry anything for chest pain besides "MONA" anyways.


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## WolfmanHarris (Feb 8, 2011)

Thankfully our interpretation is well trusted by our receiving facilities and decisions are made based on our 12's. 

My favorite moment was when we brought in a Pt. w/ atypical chest pain, decided not to treat as ischemic based on presentation. 12 lead had no ST-changes but for lack of a better term just looked wonky. (Wish I had a copy.)

Arrived at emerg, gave report and showed the 12-lead to the RN, she looked at it and reacted the exact same we did. "Huh?" Grabs one of the Doc's walking by and has him look at it. He looks and says "Okay well what we have here is... wait. Huh?" Walks over to our stretcher, looks at the Pt. gets out report. Asks us to print another 12-lead. (Which looks the same as the 1st) Looks at the ECG, says "Well, that's odd." Walks away with the ECG. Comes back 2 minutes later and just says, "Let's get her a monitored bed. Draw some bloods and I think I'll have cardio come take a look."

I felt way better about being confused as heck at that point.


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## Mile High Medic (Feb 9, 2011)

*12-lead transmissions*

The system that I came from in Texas started transmitting 12-leads for all cardiac pt's.  I am by no means a 12-lead expert but I do 12's mainly out of curiosity.  The system switched that if we did a 12 it was sent.  The hospitals received them and the ER docs would look at them but it never changed their response.  I believe the statistic is less than 30% of all AMI's show any EKG changes.  I think they are a good tool to use in the field but ER's especially in big cities don't even listen to half of our radio report anyway.  Plus to be redundant they perform there own anyway.  I would seek second or third opinions from multiple cardiologists and take everything with a grain of salt.  No disrespect but I have shown 12-leads to different cardiologists and each one of them gave a different explanation.  12-leads are strangely subjective in interpretation.  I had a pt with 3mm elevation in four contiguous leads.  They heard age and race and immediately discounted an AMI without even assessing the pt.  Right or wrong they use more than the 12-lead to form there diagnosis, yet in the last 6 months in Ft. Worth there has been a 12 and 15 year old with an MI.  Helpful tool to send it, yes.  But personally I think it is a waste of time that I would rather spend assessing and treating my pt but depends on your system and how the docs think of your assessment and judgment.


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## Mile High Medic (Feb 9, 2011)

Just started a new job in Denver that doesn't transmit.  I guess I will see if that changes my opinion.


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## 22cent (Feb 10, 2011)

I work on the western slope and the 12lead interpretation is added as a criteria for getting a cath lab activation. They will only put out an alert if the Pt isn't symptomatic or they don't fit the risk profile. I think in many cases they wait for enzymes to come back before they move forward.


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## Bieber (Feb 11, 2011)

We don't transmit, but we give copies of all our 12 leads to the ER staff and if it's a STEMI there's almost always a cardiologist waiting to see the 12 lead the moment we arrive.  Time in the ER is minimal for STEMI's, just about long enough for the cardiologist to confirm the EKG findings we reported over the radio before they wheel 'em on up to the cath lab.


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## sir.shocksalot (Feb 12, 2011)

Mile High Medic said:


> Just started a new job in Denver that doesn't transmit.  I guess I will see if that changes my opinion.



It depends on the agency. Most medic programs in CO and employers really emphasize strong 12 lead skills because no one transmits (at least in the Denver Metro area). Calling a false STEMI alert usually results in some time with the Medical Director getting your *** chewed. That being said some agencies that will go unnamed in East Denver will routinely call false STEMI alerts and never hear about it. Denver's system works well but puts a lot of emphasis on Medics knowing STEMI criteria and using good clinical judgement.


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## MrBrown (Feb 12, 2011)

Brown strongly believes in Paramedic-led interpretation of ECG however transmitting it to hospital so they have it is not a bad thing, however you should not be transmitting it for interpretation or relying on machine interpretation.

Somebody should go tell the Los Angeles County Fire Department Paramedics.


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## HappyParamedicRN (Feb 19, 2011)

Around here it depends on the hospital.  There are one or two that prefer we transmit for cath lab activation....  We also must transmit if we want to give Heparin in the field for STEMIs.

Happy


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## Jon (Feb 20, 2011)

Both my 911 services can transmit, the transport company can't. Either way, I call it as I see it, and a copy of my 12/15 lead goes to the ED Staff on transfer.

Locally, hospitals will activate cath labs off of our EKG's, but the docs like to see it to be sure.


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