Counties/States with the least progressive Cardiac protocols

[Amberlamps916]

As I'm going through my Paramedic course, we've been discussing certain counties and their cardiac protocols. LA County has been the butt of many jokes with their "Chest Pain" protocols while San Bernardino, Riverside, and Kern counties have been touted as progressive. I was also amazed to hear that LA county downgrades many cardiac patients who should recieve 12 leads down to BLS level transports.

So, after reading/hearing how counties differ in regards to ALS cardiac care, I would like to hear from you guys regarding your own county/state protocols and whether they are progressive compared to most EMS systems.

 

[DesertMedic66]

Riverside county is not very progressive when compared to most EMS systems. But it is progressive when it is compared to LA county haha

 

[JPINFV]

Riverside county is not very progressive when compared to most EMS systems. But it is progressive when it is compared to LA county haha

It didn't help when Riverside County decided to play the "paramedics can't read EKGs" game for about a year before allowing interpretation again.

Orange County may be on comprehensive standing orders, but there's still more derp present than at the annual Tea Party/Occupy Wall Street softball game.

http://www.ochealthinfo.com/docs/medical/ems/als-stoporders/SO-C-15.pdf

Note number 8. PRC = Paramedic Receiving Center = normal ER.

 

[Amberlamps916]

Really? What was the story behind the EKG interpretation fiasco?

 

[JPINFV]

I'm honestly not sure what the rational for changing from paramedic interp to machine only interp to either paramedic interp or machine interp (current protocol).

 

[Jambi]

Riverside county is not very progressive when compared to most EMS systems. But it is progressive when it is compared to LA county haha

The truth

 

[Shishkabob]

"California" and "progressive" really should never be uttered in the same sentence when speaking about EMS, unless the words "is not" are also in there...

 

[Amberlamps916]

I'm not limiting answers to California only.....

 

[DesertMedic66]

"California" and "progressive" really should never be uttered in the same sentence when speaking about EMS, unless the words "is not" are also in there...

Hey hey hey, be nice

 

[Christopher]

As I'm going through my Paramedic course, we've been discussing certain counties and their cardiac protocols. LA County has been the butt of many jokes with their "Chest Pain" protocols while San Bernardino, Riverside, and Kern counties have been touted as progressive. I was also amazed to hear that LA county downgrades many cardiac patients who should recieve 12 leads down to BLS level transports.

So, after reading/hearing how counties differ in regards to ALS cardiac care, I would like to hear from you guys regarding your own county/state protocols and whether they are progressive compared to most EMS systems.

We're part of a larger system of STEMI activation and transfer under a combined EMS/Hospital program in North Carolina. We're broken up into regions and each region determines the appropriate strategy for ensuring timely D2B and/or D2N times.

Whether this is your community access hospital pushes lytics and calls for an emergent ground/air transport to a pPCI facility or EMS captures a 12-Lead in the field and skips the community access hospital going for a pPCI facility.

In our area our protocols dictate that we will acquire and interpret a 12-Lead ECG, and if a STEMI is present we will bypass any non-PCI center for the PCI center. Often our activation will allow us to bypass the ED entirely.

 

[d_miracle36]

While I don't consider our protocols advanced our service does allow us to transport directly to the cath lab. We do not transport to facilities who make us stop and wait in the er.

 

[marcus2011]

In the county I work for we are pretty aggressive with all protocols. Good thing is we about 20 minutes either way from a level one trauma center and cath labs.

 

[fast65]

I don't particularly consider our cardiac protocol "progressive". If we have a STEMI patient, we notify the receiving hospital, and launch the chopper to said ED. Unfortunately for us, the closest PCI center is between 1-1.25 hours away depending on which end of the system you're on. That being said...it would be nice to have the option of bypassing the ED like the county next to us...

 

[Handsome Robb]

Any reason why it's limited to "least progressive" systems?

I feel as though we are on the opposite spectrum. I wouldn't say we are crazy progressive but we do activate cath teams without consultation from a physician, that being the paramedic on scene is interpreting the 12-lead and saying STEMI or no STEMI. Once we arrive to the hospital a doc confirms it. We do the standard 324 of ASA, NTG either spray, paste or a combo of the two, and/or MS. We can skip to MS if they are hypotensive or right on the edge or inferior/RVI. We give metoprolol for tachycardic and hypertensive STEMIs (HR >100, SBP >140), and also draw labs in the field. We have 3 PCI centers within 15 minutes of eachother. We are consistently under 60 minutes for door to balloon times and it isn't unusual for us to be under 30 minutes for door to balloon times. If we have everything lined up with proper notification we can generally bypass the ED (quick stop for a hospital 12-lead) and go straight to the cath lab with the patient on our gurney.

Edit: For tiered systems what happens if a BLS truck shows up to a SNF and is handed a 12-lead interpreted by someone with the ability to interpret them as a STEMI? Do you wait for ALS or just pick up and haul *** to the closest PCI center?

 

[Amberlamps916]

Hey Nvrob, I wasn't sure how to edit the title of the thread. I don't want to limit it to just the least progressive, rather, let's hear from everyone. Keep 'em coming....it's very informative.

 

[med51fl]

Our county has a STEMI network. The cardiac protocol is pretty standard (oxygen, ASA, NTG, MS). The paramedic activates the cath team at the closest STEMI center (there are 12 in the network) from the scene. The hospital has 60 minutes door to balloon. If the hospital cannot meet the required 60 minutes, they are removed from the network.

 

[Tigger]

Any reason why it's limited to "least progressive" systems?

I feel as though we are on the opposite spectrum. I wouldn't say we are crazy progressive but we do activate cath teams without consultation from a physician, that being the paramedic on scene is interpreting the 12-lead and saying STEMI or no STEMI. Once we arrive to the hospital a doc confirms it. We do the standard 324 of ASA, NTG either spray, paste or a combo of the two, and/or MS. We can skip to MS if they are hypotensive or right on the edge or inferior/RVI. We give metoprolol for tachycardic and hypertensive STEMIs (HR >100, SBP >140), and also draw labs in the field. We have 3 PCI centers within 15 minutes of eachother. We are consistently under 60 minutes for door to balloon times and it isn't unusual for us to be under 30 minutes for door to balloon times. If we have everything lined up with proper notification we can generally bypass the ED (quick stop for a hospital 12-lead) and go straight to the cath lab with the patient on our gurney.

Edit: For tiered systems what happens if a BLS truck shows up to a SNF and is handed a 12-lead interpreted by someone with the ability to interpret them as a STEMI? Do you wait for ALS or just pick up and haul *** to the closest PCI center?

Call for an intercept while preparing for a quick trip to the hospital. In Boston it's usually easier to just get to one of the like 10 hospitals nearby and ALS is called more as a formality. Waiting for ALS is unnecessary unless there is no way for them to meet you on the way to the appropriate hospital.

 

[medicsb]

We give metoprolol for tachycardic and hypertensive STEMIs (HR >100, SBP >140)

Any system using beta-blockers outside of clinical trials are acting in a non-progressive manner. It is interesting that some places still consider HTN and tachycardia to be indications for use of beta-blockers, as those subsets of patients fared the worst in COMMIT. The ones that did the best (relatively) were the patients who were normotensive and with a "normal" HR. It actually makes sense when you consider the physiologic response to a decrease in cardiac output.