Here is one article that does discuss the stat EEG in the ED for different circumstances.
http://www.jordaneuro.com/sitebuildercontent/sitebuilderfiles/eeg.pdf
Many Trauma centers also have the capability of doing continuous EEG monitoring in their ICUs where the patient should be taken after the initial interventions are made. Other studies for TBI have also compared the Glascow scale for severity to EEGs done a couple of days later and found the Glascow scale to predict severity relatively well.
The above article also discusses equipment and qualified neurophysicians to interpret. Again, the same issues I mentioned.
There are also other diagnostics used for TBI such as cerebral angiography, transcranial Doppler ultrasound, and single photon emission computed tomography (SPECT). The CT Scan and MRI are still widely use but other equipment may be used but the type may also be influenced by a sale from someone who has extensively studied one piece of equipment and presents their research effectively at a "summer class". If it was a panel discussion, you might hear the pros and cons as well as the advantages of the other technologies.
When one is not fully familar with medicine or a particular procedure it is easy to be convinced about one way or one product. CPAP is a great example. Look at the many departments that have been sold something little more than an oxygen mask with an effort dependant exhalation resistive valve. Yet, some are convinced it "saved" their one and only one patient they tried it on and without any other prehospital intervention but was put on a 2 L NC in the ED. CPAP can be effective in the field but one must understand their equipment, the patient and the limitations of both. I did CPAP on transport 30 years ago with back breaking, gas hungry equipment and anxiously awaited the day for something portable. The same for the IABP, VADs and ECMO. Again I will mention the ultrasound but unless it will make a huge difference in your destination or treatment which can not be otherwise determined by physical assessment, it might just become an expensive vein finder.
Also, with CPAP, some complain they are tied up in the ED while the equipment change is made. Are you going to leave behind $20K in equipment at a hospital? Your recording for just a few minutes may reflect little. Will you be certain your equipment is compatible with all the hospitals? I can tell you that seldom will two hospitals in the same city use the same equipment.
I could also use the hypothermia protocol as an example. Of what use is it if the hospital you transport to does not utilize the protocol? You may not even reach target temperature upon arrival to the ED and it will be discontinued. I also find 12-lead EKGs to be of little credible value if the provider does not know how to interpret and must rely on the machine interpretation if they have no way to transmit the actual test to the ED physician.
Yes technology has improved to make these things possible for transport but there are still things in prehospital that make some diagnostics difficult due to a time element, environment and other priorities. If there is an ICH with active bleeding, is the EEG really the priority? Also, mild TBIs might be missed by the EEG if there are no abnormalities in the electrical activity. Should there be over confidence in the EEG finding without the CT Scan or MRI?
I would say that doing a great phyical assessment and relaying this information to a hospital might get the appropriate testing done quicker which might be the EEG. I already mentioned we may monitor a patient receiving treatment with a continuous EEG. The EEG equipment can be initiated while the patient is undergoing other quick diagnostics and treatment is being started. RTs will do the set up for EEGs during off hours for a variety of reasons and potential diagnosis. As long as the patient is in a monitored bed with a nurse or sitter around, no problem. The technology will do its job. However, calibrating and the setup is time consuming and hopefully the hospital will have a neuro on call. Technology is great providing you have ALL the factors in order can prioritize what should come first in the care of the patient.
