EMT Bs and a 12 lead

[MrBrown]

That could be a good thing provided the other hospital is within a very reasonable distance. I would hate to think of the bad outcomes if this is a BLS truck that can only rely on speed when the BP is dropping or the rhythm changes to VT/VF while bypassing another hospital and is at the point of no return. It is one thing to bypass hospitals if you are ALS and have similar capabilities as to what would be initially done in an ED but it is a whole other pandora's box to tell a crew with nothing more than first-aid training and an 12 - lead EKG skill to bypass and keep going just by a transmitted piece of paper and a BLS assessment. Would they also be trained to recognize rhythm changes that might require immediate attention? They would also be speeding into the further ED with no IV access (not that they should be taking more time at scene to do that either at a BLS level) and probably a very sick patient if nothing else from a very scary ride.

No it's not a good thing. My experience with American basic life support is not first hand but I understand it to be somewhat archaic and totally inappropriate for this sort of procedure. Even here where our BLS is a mix of BLS and ILS, I would advocate it inappropriate for bypassing a facility with a suspected STEMI patient onboard.

If the transport time was LESS than a defined margin (say 15 minutes) and the patient was fairly stable in terms of cardiac rhythm (not throwing PVcs, runs of VT etc) I may consider entertaining the idea.

 

[VentMedic]

I often refer to the OPALS study in Ontario as an example of misinterpretation amongst American providers. It was done using the equivalent of Ontario's BLS education which is almost a year and not the 120 hours of the U.S. EMT-B. However, some in the U.S. have continued using that study for the BLS vs ALS arguments when the meaning of BLS of the study did not exclude assessment from a more educated level.

 

[MrBrown]

I often refer to the OPALS study in Ontario as an example of misinterpretation amongst American providers. It was done using the equivalent of Ontario's BLS education which is almost a year and not the 120 hours of the U.S. EMT-B. However, some in the U.S. have continued using that study for the BLS vs ALS arguments when the meaning of BLS of the study did not exclude assessment from a more educated level.

I just skimmed that OPALS report, seems very interesting, will have to read it later.

While I think the US is doing some positive things in prehospital medicine such as the introduction of rapid sequence intubation (mind you we have that, and the US have used it since the war in Vietnam), thrombolytics (but we have that too), corticosteriods for asthma/anaphylaxis and despite the "EMS agenda for the future: a systems approach" the distinction between BLS and ALS is still very clear cut.

As much as I'd like to work on the streets of NYC, Los Angeles or San Francisco (those are systems I have first-hand experience in visiting) I just couldn't work in the United States -- at your equivalent level (BLS) anyway!

 

[TomB]

I'll take my chances! I'd rather have a BLS ride and primary PCI in 60 min than a BLS ride and fibrinolysis in 30 min (or transfer PCI), but that's just me! 50% of STEMI patients self-report to the hospital anyway, and BLS can defibrillate. In a perfect world, all STEMI patients would get ALS transport to a PCI center. Regardless of your view, it is happening in some areas of the country, so we should have some real data to help support our opinions soon enough.

Tom

That could be a good thing provided the other hospital is within a very reasonable distance. I would hate to think of the bad outcomes if this is a BLS truck that can only rely on speed when the BP is dropping or the rhythm changes to VT/VF while bypassing another hospital and is at the point of no return. It is one thing to bypass hospitals if you are ALS and have similar capabilities as to what would be initially done in an ED but it is a whole other pandora's box to tell a crew with nothing more than first-aid training and an 12 - lead EKG skill to bypass and keep going just by a transmitted piece of paper and a BLS assessment. Would they also be trained to recognize rhythm changes that might require immediate attention? They would also be speeding into the further ED with no IV access (not that they should be taking more time at scene to do that either at a BLS level) and probably a very sick patient if nothing else from a very scary ride.

 

[VentMedic]

One more argument for BLS only and EMT-Bs to not advance to the next level.

It is all fine provided you survive to the hospital.

 

[bstone]

When I worked BLS we carried no EKG. As an Intermediate 3-lead EKG is standard. We were not trained in 12, but learned it from the medics we work with.