Do you have a cardiac monitor on a BLS rig?

[Tigger]

I'm fairly sure the LPs have a similar option. Not sure about any other manufacturers, though.

For a BLS service, it might be cheaper (hence, preferable, if cost is a major concern) to have a single-role AED, let the intercepting ALS unit stock the monitor. I'd imagine this is standard practice for many services, given the cost of a monitor/defibrillator.

An MRx can be locked out as well. Seems like this might work well for your agency so you don't need two devices?

Of note, every ambulance in South Dakota has a cardiac monitor on board as a result of a 8.4 million dollar grant. BLS crews are placing twelve leads and transmitting them for interpretation to allow for early cath lab activation or potentially helicopter transport if in a very rural area. ALS is few and far between out there. Here's an article, I used to have some more info about the program but I can't find it.

 

[mrg86]

My agency has a LP12 on our BLS unit. Our EMTs are trained to set up 12 leads and use it in AED mode on arrests. If the call starts off BLS and gets balanced to a medic response, the arriving medic will usually get handed a 12 lead strip when they walk in.

 

[Clare]

There is no transmission of ECG for interpretation here, this should not be occurring, if you cannot interpret an ECG then something is very wrong.

 

[MidwestEMT]

our local service carries the LP15 on both our BLS and ALS rigs. They have the previously mentioned lockout for manual defib. As basics, we use it mainly for spO2, pulse, and transmitting 12's to the receiving facility if requested or if thought necessary.

Most of our Basics are very good at continuing education, and learning because they want to, not need to. That being said, almost all of us are able to interpret at least a few common rhythms, and while we aren't 'trained' to diagnose different rhythms, we can give incoming medics a heads up.

 

[Handsome Robb]

There is no transmission of ECG for interpretation here, this should not be occurring, if you cannot interpret an ECG then something is very wrong.

Or you work as a lower level provider in a region where providers educated in 12-lead interpretation are few and far between so BLS ends up managing and transporting these patients.

I agree that the Medic should be interpreting the 12-lead but in areas where there isn't always a medic available how is acquiring and transmitting a 12-lead in patients with suspected ACS a bad thing?



Only BLS crews in the county I work in are special events crews. They carry Philips AEDs. All ambulances are ALS and carry the MRx. Some special events crews are ILS and they will usually have an MRx they can use in AED mode and for pulse oximetry and to capture 12-leads for the incoming ALS crew since they have a few extended protocols over ambulance Intermediates after they request ALS backup.

 

[EMT B]

my system we use lp15 on the trucks. all of our trucks are als equipped. it is very very rare that we have no als on duty though.

 

[EpiEMS]

There is no transmission of ECG for interpretation here, this should not be occurring, if you cannot interpret an ECG then something is very wrong.

What are the BLS providers expected to interpret? Normal vs. not normal? Or identify specific rhythms, etc.?

An MRx can be locked out as well. Seems like this might work well for your agency so you don't need two devices?

That'd be preferable, I would think -- may as well already have the monitor/defibrillator all ready to go when ALS shows up.

 

[systemet]

There is no transmission of ECG for interpretation here, this should not be occurring, if you cannot interpret an ECG then something is very wrong.

In an ideal world, BLS providers would be taught to capture and interpret a 12-lead. Unfortunately in some places the training programs are so short that this becomes problematic. I would rather have them capture, check whether the rhythm strip says "Acute MI suspected", and be able to transmit, that not be able to apply a 12-lead at all. This is a skill that really should be available on every ambulance.

At an ALS level, it's really nice to be able to send a borderline ECG past a physician. We're fortunate enough to have access to a team of physicians that can direct us to bypass the ER and go direct to cathlab, or to give TNKase, depending on the patients condition, risk factors, and the availability of local cathlab suites. This is invaluable. I think, as paramedics, we can do a very good job of calling obvious STEMIs. The problems occur when the changes are borderline, or when we need to start assessing more complex risk/benefit issues, like the relative benefit of PCI vs. lysis in grey situations.

 

[Christopher]

And why would you use it?

To determine rate and rhythm of the heart? EMT's can only interpret if a rhythm is regular or irregular?

And just wondering, if a patient went into cardiac arrest, would you look at the monitor or check carotid artery?

We carry cardiac monitors on our industrial fire brigade, but to do 12-Leads, NIBP, SpO2, and EtCO2.

If necessary, paramedics (who utilize the same brand) in our county can unlock the full ALS features.

At my fire department our BLS/ILS crews also carry the same cardiac monitor as our ambulance does, this way if a medic hops onto their truck they can roll with what they have.

 

[Christopher]

That'd be preferable, I would think -- may as well already have the monitor/defibrillator all ready to go when ALS shows up.

All major brands of cardiac monitors can be locked out for BLS providers.

 

[VFlutter]

There is no transmission of ECG for interpretation here, this should not be occurring, if you cannot interpret an ECG then something is very wrong.

You do not transmit STEMI EKGs? I do not necessarily agree with that. It is nice for the cardiologist to have a copy of the EKG in hand before the patient arrives in the ER or cath lab.

 

[Christopher]

You do not transmit STEMI EKGs? I do not necessarily agree with that. It is nice for the cardiologist to have a copy of the EKG in hand before the patient arrives in the ER or cath lab.

We've got a system that works exceedingly well without transmission. Only necessary if the providers cannot interpret the ECG's.

 

[NomadicMedic]

We also do not transmit ECGs. Our system works very well without it.

The medial directors are very involved with our education, know all the medics by name and since we all see them frequently, it's not uncommon for one of the docs to just flip you a 12 lead and say "what is this?"

 

[Tigger]

There is no transmission of ECG for interpretation here, this should not be occurring, if you cannot interpret an ECG then something is very wrong.

I don't know how your rural ambulances are staffed, are ambulances nation wide crewed by at least one paramedic or do units exist with only EMTs staffing them?

Seems like an EMT only ambulance could benefit from transmitting EKGs to the hospital since they already have the monitor...

 

[WolfmanHarris]

Our BLS trucks and American ones are quite different. All Primary Care Paramedic (BLS) trucks are equipped with a monitor with 12 lead capability. All PCP's are trained to interpret and no transmission is done. One of the medical direction programs I'm aware of emphasizes machine interpretation over medic for their STEMI program, but they are the exception. We are required to bypass on our own interpretation only. It's a weird quirk of the system where almost every directive is the same across the province save STEMI since those are regional agreements with the PCI lab.

 

[Bullets]

Our ambulances only carry AEDs, Cardiac Science. Town got a grant and got an AED for every PD (20), FD (14), EMS (20), OEM/Hazmat (5) vehicles and the schools. Near on a hundred AEDs in town.

Our day to day EMS takes BPs manually, checks pulses manually, though we do carry Rad-57s to measure Oxygen and CO

We have 2 MCI units, one has 4 Welch Allyn monitors that do NIBP, Pulse Ox, and 3 leads. Our MCI bus had 10 of these new ATHENA GTX wireless monitor, also do NIBP, O2 and 3 leads and can transmit them over bluetooth to a central monitoring station.

 

[EpiEMS]

Any use in having the AEDs that give a 3-lead rather than just the regular AED?

 

[Tigger]

Any use in having the AEDs that give a 3-lead rather than just the regular AED?

Most of the AEDs that are 3-lead capable are also marketed as tougher than your "average" AED. That's why we have Zoll AED Pros instead AED Plus models I am told.

Besides that I can't come up with much. If a BLS unit is getting an intercept I would expect ALS is bringing a monitor. I suppose ALS could use the three lead function during an already "in progress" arrest to save time and check for rhythm. If someone arrests in front of me the AED is going on immediately and staying on even if it doesn't shock, so all they would have to do is unlock and voila, three lead. Of course we have Zoll monitors too so they could just plug in our pads to their monitor...

 

[EpiEMS]

Most of the AEDs that are 3-lead capable are also marketed as tougher than your "average" AED. That's why we have Zoll AED Pros instead AED Plus models I am told.

Besides that I can't come up with much. If a BLS unit is getting an intercept I would expect ALS is bringing a monitor. I suppose ALS could use the three lead function during an already "in progress" arrest to save time and check for rhythm. If someone arrests in front of me the AED is going on immediately and staying on even if it doesn't shock, so all they would have to do is unlock and voila, three lead. Of course we have Zoll monitors too so they could just plug in our pads to their monitor...

Yeah, I can't quite see where it'd be useful, barring the 3-lead capable AEDs actually being tougher.

ALS comes, ALS uses an ALS monitor, that's really all there is to it, I suppose.

 

[Outbac1]

By basic interpretation, do you mean that the PCPs are doing a 12-lead so as to determine "This is normal, we can transport" versus "This is abnormal, let's contact ALS for an intercept (or alternatively pre-notify)"? Or is it in greater depth?

Sorry for the delay in replying I've been working or away.

Our PCPs will interpret sinus rhythms, a-fib, v-fib, v-tach, and look for ST elevations on 12 leads. Most do rely more on the monitors interpretation than their own. And lets face it most of the time the monitor is right. They will use that info to call for ALS backup or to notify the hosp that they are bringing in a probable STEMI. With advance notice the door to drug time can be as little as 10 min. Our nearest cath lab is 100 miles away.

Please keep in mind that most of our PCP (Primary Care Paramedic), programs are longer than many "Paramedic" programs in the US. The scope of practice of PCPs here is considerably more than a "Basic". It is not a fair comparison to try and compare our "BLS" to yours.