12 Lead ecg

[bdoss2006]

I know scope varies by state and so do protocols, but I am just looking for a general guideline. If an EMT obtains a 12 lead, can they go by the ecg machine interpretation to advise the patient as far as a refusal goes, or does it have to be transmitted to the hospital? I’m in Virginia by the way. I know we can obtain and transmit them, but can we obtain one and go by the interpretation to advise about a refusal?

 

[luke_31]

I don’t believe so but I’m not in Virginia. However there are several issues with just going off what the computer interpreted on a 12-Lead. To start the interpretation isn’t always right, there may be subtle changes that it misses, if you incorrectly place the leads you can get incorrect readings, reading 12-leads is not just is there a STEMI or not there are several things that can be learned from looking at the 12-lead and a good patient assessment.

 

[BobBarker]

I know scope varies by state and so do protocols, but I am just looking for a general guideline. If an EMT obtains a 12 lead, can they go by the ecg machine interpretation to advise the patient as far as a refusal goes, or does it have to be transmitted to the hospital? I’m in Virginia by the way. I know we can obtain and transmit them, but can we obtain one and go by the interpretation to advise about a refusal?

Most states that I know of has 12lead placement as a basic skill but 12 lead interpretation as an advanced skill. Interpretation is a lot more than just reading what the computer says. For a refusal, it doesn't matter what the 12 lead says, if a patient is alert and oriented, they can refuse care. Of course I am going to advise them of the risks for declining transport/hospital care, a little more so if I think it's a ***STEMI*** lol.

 

[Tigger]

I think it would be unwise to base any of the refusal process on the monitor’s interpretation, which is not known for its steadfast accuracy.

Not that paramedics and doctors are either. The EKG is just one piece of a refusal.

I would not want an EMT using the monitor at all to obtain a BLS refusal. You don’t know what you don’t know.

 

[EpiEMS]

Obtaining a refusal on the basis of an interpreting diagnostic tool that is outside of your education, credentialing, and licensure is problematic. I’m in favor of BLS 12-leads but machine interpretation should not be used to rule out a problem (as opposed to ruling in a possible problem).

If you were to use it as a piece of evidence for a refusal in consultation with an online medical consult, I could get behind that (transmit the ECG, let the physician speak to the patient) perhaps.

 

[M3dicalR3dn3ck]

Just do what we can do in Oklahoma: get on the horn with OLMC, transmit the 12-Lead for interpretation, document the consult and doc who gave it. But I ain't getting a refusal without CRC consult AND OLMC consult if the doc says that there's anything concerning

 

[EpiEMS]

Just do what we can do in Oklahoma: get on the horn with OLMC, transmit the 12-Lead for interpretation, document the consult and doc who gave it. But I ain't getting a refusal without CRC consult AND OLMC consult if the doc says that there's anything concerning

This right here.

And only if protocol & agency policy permit this. I’d move heaven and earth to get an ALS unit to me or convince the patient to be transported in this circumstance.

 

[CCCSD]

Just believe that every piece of electronic diagnostic equipment is perfect and will never lead you astray. Trust them.

 

[M3dicalR3dn3ck]

We're absolutely allowed

This right here.

And only if protocol & agency policy permit this. I’d move heaven and earth to get an ALS unit to me or convince the patient to be transported in this circumstance.

We're absolutely allowed to do that by protocol at both of my jobs. I'd base requesting ALS intercept on my location though, because at my full time job, our two east side stations are close enough to Tulsa that I'd be delaying care. Our west side stations and my part time job are far enough out that I can reasonably request intercept. In any case, we are not legally allowed to interpret EKGs ourselves, but nobody will question me if I report that the ER doc said it's this.

 

[Capital]

There is no general guideline for refusals in Virginia. Every agency has its unique protocols that outline how refusals must be obtained. Example: My current agency requires a call to the Peds ER doctor for any peds refusal under the age of 5, never encountered that before.

Side note from the ER side of things -- so many poorly done EKGs are transmitted to our ER daily, placement matters people!

 

[FiremanMike]

I am not a fan of this in the slightest..
1. 12-lead interpretation from the monitor is inconsistent at best and frequently inaccurate
2. 12-lead is a small piece of the puzzle for cardiac issues.. NSTEMIs are more frequent than you think
3. We really shouldn't be turfing people we think may be cardiac cases