Assumed Wrong on a TIA

Sasha said:
I'm hurt you can't seem to think past a blanket statement.

What does this patient need? I think we can all agree this patient needs a hospital.

Whoever can get them there the quickest should go ahead and take them. Soemtimes ALS gets so wrapped up in "ALS procedure" that they delay on scene time and getting them to that hospital.
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This pt needs a particular kind of hospital, if at all possible. The local community hospital that is 15 blocks away wouldn't be the best choice if there is a stroke center 30 blocks away. While there isn't a lot that will be done by a paramedic for someone having a relatively uncomplicated stroke that will help fix the problem versus a basic, as happens normally, recognition of what is happening is key. Knowing that they are having a stroke (or are at high risk for one) and being able to start going through inclusion/exclusion criteria (though this will get redone) is a better thing to do than just toss on a gurney and go.
 
medic417 said:
No delay. OP even said they were not closer to hospital. IV and blood draw in route. 12 lead ads 30 seconds to scene time. wow we now call hospital with more complete details they gather stroke team. We get checklist started. Get there they complete checklist and boom. By adding 30 seconds we saved minutes if not hours depending on the ER. And again some services now administer.
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Thats with the assumption that ALS is not 20 minutes out. Perhaps they weren't closer to the hospital, but that doesn't mean they'll be there in 2-3 minutes.

I agree they need to be taken to a stroke center (perhaps we're spoiled here, all but one hospital with in a 20 minute travel time from the area I do rides are stroke centers.) but what kind of genius does it take to recognize a stroke? If an EMT is not capable of that, then perhaps they should revisit EMT school.
 
Sasha said:
...what kind of genius does it take to recognize a stroke? If an EMT is not capable of that, then perhaps they should revisit EMT school.
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Practicing physicians -- with at least 9 years of education -- have a 75 percent success rate at accurately diagnosing strokes with only an initial physical examination. Now, do you really think that 120 hours of technical training -- most of which is focused on trauma skills -- is likely to result in a more impressive competency rate?
 
AJ Hidell said:
Practicing physicians -- with at least 9 years of education -- have a 75 percent success rate at accurately diagnosing strokes with only an initial physical examination. Now, do you really think that 120 hours of technical training -- most of which is focused on trauma skills -- is likely to result in a more impressive competency rate?
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Is a paramedic?
 
medic417 said:
ALS can start process for that fancy new fangled thrombolytic drug. Some even can administer it.
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Really? And which service is this that can rule out hemorrhagic vs ischemic stroke in the field?
 
Scott33 said:
Really? And which service is this that can rule out hemorrhagic vs ischemic stroke in the field?
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None that I know of carries thrombolytics for CVA's. Some for MI's although that has been called into question in the last 5 years or so. Best thing a paramedic can do is recognize the problem, get them to the right place, and start screening them for thrombolytics.
 
Precisely.

A few places in the county, and many places in the world, routinely give thrombolytics prehospitally. For MIs not for CVAs.
 
Look into the field trials of Factor VII. There are great trials going on with it. One of the flight services in FL has been testing it for a few years now. This is where thrombolytics for CVA's may come into the prehospital environment. It is interesting how the two work together on any type of CVA.
 
Sasha said:
Is a paramedic?
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Depends on the paramedic. I don't have a lot of confidence in the competence of most paramedics either. But yes, there is a much greater possibility that they are more competent at physical examination and diagnosis than someone with three weeks of night school.
 
reaper said:
Look into the field trials of Factor VII. There are great trials going on with it. One of the flight services in FL has been testing it for a few years now. This is where thrombolytics for CVA's may come into the prehospital environment. It is interesting how the two work together on any type of CVA.
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Got anymore info on that? At a quick glance it seems like the initial results from testing Factor VII on hemmorhagic strokes weren't as good as was thought. I can see how they could be used in conjunction with each other, but it seems like it'd be a touchy situation with the need for almost constant labs...not something we can really do unfortunately.
 
http://www.medwire-news.md/39/78534/Stroke/Pre-hospital_triage_boosts_stroke_thrombolysis_use.html

"MedWire News: Use of a pre-hospital stroke assessment tool by ambulance staff leads to a large increase in the proportion of patients receiving thrombolysis treatment, say Australian researchers.

Implementing the process resulted in a four-fold increase in stroke thrombolysis, Christopher Levi (Hunter Medical Research Institute, Newcastle) and colleagues report in the Medical Journal of Australia."

Guess ALS assessment is just not that important after all.:rolleyes:
 
medic417 said:
http://www.medwire-news.md/39/78534/Stroke/Pre-hospital_triage_boosts_stroke_thrombolysis_use.html

"MedWire News: Use of a pre-hospital stroke assessment tool by ambulance staff leads to a large increase in the proportion of patients receiving thrombolysis treatment, say Australian researchers.

Implementing the process resulted in a four-fold increase in stroke thrombolysis, Christopher Levi (Hunter Medical Research Institute, Newcastle) and colleagues report in the Medical Journal of Australia."

Guess ALS assessment is just not that important after all.:rolleyes:
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Uh...did you actually read that or just post it? Because...hate to tell you...it doesn't help your arguement about having paramedics available all the time.
The Pre-hospital Acute Stroke Triage (PAST) protocol is based on four elements: the presence of hemiparesis, impaired speech, and normal glucose levels, and a time from symptom onset of less than 2 hours.

If ambulance personnel find a patient meets these criteria, is older than 18 years old, and is normally ambulant, then they activate the Stroke Intervention Protocol. This involves taking the patient directly to a hospital providing specialist stroke services, and pre-notifying hospital staff of the patient’s arrival.
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All that is is another version of the LA stroke scale, with a couple things removed.

While not knocking what they are doing, it isn't anything that extradordinary.

Edit: If you want to argue for having paramedics treat a specific problem, you need to give out good, accurate reasons. The above is not one unfortunately.
 
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Errr.

Your link to an Australian EMS piece of research is higlingting the need for a rapid neuro assessment. It is basically a modified Cincinatti stroke scale with blood sugar tagged on. No reference is given to ALS vs BLS interventions, and the use of prehospital thrombolysis for CVA is still noticably basent.

Nothing that most of us didn't already know.

Incidently, with the Australlian system, some of their BLS providers a referred to as Paramedics, depending on what part of the country they are in.
 
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My point with that study is that EMS does play a part in improving patient outcome. In the USA the basics are not educated enough to do the assessment. Based on the assessment in the field patient care improved. So common sense says having a Paramedic perform said assessment would improve patient outcome because even treatment at the hospital would improve by being activated much quicker.
 
reaper said:
I have had no luck on finding a newer report on the Factor VII issue. This one is a few years old. All the articles I read, pretty much refer to this one article.

http://content.nejm.org/cgi/content/abstract/352/8/777
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That was one I saw.

http://www.medscape.com/viewarticle/557558
Not definative, they just agree that more study needs to be done. Definetly seems like something that could be beneficial for hemmorhagic strokes and potentially hemmorhage in general (couple studies on that had similar results as above; more research is needed)
 
medic417 said:
OP says not closer to hospital so should have stayed and waited for ALS. Again another arguement for a Paramedic on every ambulance.
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I was in New York City over the weekend and was a bystander to an elderly woman falling and fx her hip. The responding crew was BLS, two Basics. The lady needed fluids and pain meds. Yes, a medic on every bus.
 
medic417 said:
My point with that study is that EMS does play a part in improving patient outcome. In the USA the basics are not educated enough to do the assessment. Based on the assessment in the field patient care improved. So common sense says having a Paramedic perform said assessment would improve patient outcome because even treatment at the hospital would improve by being activated much quicker.
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medic417 said:
Guess ALS assessment is just not that important after all.:rolleyes:
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I'm pretty sure that was your point actually. It's a stretch, I know, but still...

All that study showed is that when a caregiver sees one-sided weakness, impaired speech, normal blood glucose, and a recent onset they should transport them to an appropriate, predetermined hospital that can appropriately treat them. Not rocket science I'm afraid.

If you want to show that having a paramedic perform care for specific problems is needed, you need to demonstrate why it is needed. The above does not accomplish that.
 
bstone said:
The lady needed fluids and pain meds.
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She probably got both within 10 minutes of the doors being shut, given the lack of transport time in NYC.

I do agree with the principle of a medic on every ambulance. Perhaps it would mean the end of the role of EMT-B in anything other than the driver / bag monkey role.
 
bstone said:
I was in New York City over the weekend and was a bystander to an elderly woman falling and fx her hip. The responding crew was BLS, two Basics. The lady needed fluids and pain meds. Yes, a medic on every bus.
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you were in NY and didn't call? The shame!

NYC is weird but she was probably in the hospital in 5 minutes. It isn't a defense but....
 
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