need help with WHY we need to have 12 leads

[johnrsemt]

I came from a very progressive service to a very slow service: but with the capability to have anything, money no object type place.

some of the medics are trying to convince the service that we need to have 12 lead capability; we are using Lifepack 12's without 12 leads.

our senior medic/supervisor keeps saying that it won't make any difference in pt care: I tell him he is right with a patient who is having classic MI symptoms, but on the pt's who are having odd symptoms it can make a world of difference.
such as nausea and vomiting: normal transport to small hospital with no cardiac capability 40 min away; but if I did a 12 lead and showed MI, I would intercept with a helicopter or take straight to a level 1 center with cardiac services about 75 min away.

need some good reference articles on why it makes a difference and that type of thing.

thank you

 

[Bosco578]

Curious as to how one would think it would not make a difference in pt care? Why do hospitals do 12/15 lead ECG's? Do some paramedics believe that it will not impact how soon treatment of an AMI should be treated? Field admin of Thrombolytics? Do you really want to give Nitro to an Inferior MI with RV involvement?

I think having the capability to perform 12/15 lead in the field is beneficial. Can possible speed up the door the Cath lab time. STEMI vs NON-STEMI.

If it is in your services means to have 12-Lead, then it would be a great adjunct.

 

[firecoins]

Time is what makes the difference in care. If you know a patient is having a STEMI, you would bring directly to a STEMI center.

 

[KEVD18]

some people just shouldnt be in ems

 

[JJR512]

some people just shouldnt be in ems

...Like management.

 

[MSDeltaFlt]

I came from a very progressive service to a very slow service: but with the capability to have anything, money no object type place.

some of the medics are trying to convince the service that we need to have 12 lead capability; we are using Lifepack 12's without 12 leads.

our senior medic/supervisor keeps saying that it won't make any difference in pt care: I tell him he is right with a patient who is having classic MI symptoms, but on the pt's who are having odd symptoms it can make a world of difference.
such as nausea and vomiting: normal transport to small hospital with no cardiac capability 40 min away; but if I did a 12 lead and showed MI, I would intercept with a helicopter or take straight to a level 1 center with cardiac services about 75 min away.

need some good reference articles on why it makes a difference and that type of thing.

thank you

This ought to help.

http://www.americanheart.org/presenter.jhtml?identifier=3051369

 

[mycrofft]

75 minutes? Go with twelve.

As Firecoins says, time is the difference. If the time to get the 12 lead plus the the to give the indicated intervention plus the time for it to make a difference, (if you're right) adds up to less than the transport time, it makes sense. From the administrative side, how often do these sorts of cases occur? If not often enough, or false positives are leading to unnecessary delays in transport (i.e., going to the further hospital) or calling in of an aerovac, then the twelve lead would still be prudent, but guidelines and training kept up.

Tell the boss you can make more money doing a 12 lead, that'll warm him up.

 

[Hastings]

1. Minimizes the time to in-hospital cardiac treatment.
2. Treatment (and presentation) IS sometimes different depending on the location of the MI, and if you have the education, a good medic can anticipate how the patient is going to present and react after identifying the location of the dead tissue. For instance, from the other thread, Nitro is dangerous to give to certain types of MIs. I believe having a 12 lead is not only helpful, but vital on any patient with cardiac symptoms.

 

[el Murpharino]

It's nice to know if you're having a right-sided MI before you give 'em some Nitro...

some medics are just content with archaic technology...

 

[Ridryder911]

Here is what I told my administration, when he told me that there is no difference etc.
" I would love to argue and debate this issue if you truly understood emergency cardiac care. It is obvious that you don't or we would not be having even this discussion"....... We had the 12 lead cables 15 minutes later.


"Remember those that choose to view in leads 3 cannot see"

 

[fma08]

The last pt. with an MI we had. Did a 12-lead, saw it in V1-V6, called an ACS code to the hospital in the field. Pt. was up in cath lab within 20 min of being in the ER. Pt. had a 100% occlusion of his LAD. Went home after 1 day in the hospital. When the doctor thanks you for calling something like that in the field, I'd say it is a pretty beneficial procedure.

 

[johnrsemt]

thank you for the help

any more articles; that helps the most.

the extra charge thought doesn't help; our service charges the same flat fee for all transports no matter which hospital or what is provided in the truck.

 

[Ridryder911]

You might get the attention by telling them that if there ever was a challenge in care of treatment (such as adm of NTG in right side AMI) they might be held neglible for not performing a thourough assessment. That it is considered a standard in prehospital care for the past decade.

I would ask if their would be able to rationalize NOT performing in lieu of litigation. As well, why has your medical director has not enforced this yet?

Here are are some more article:
http://content.onlinejacc.org/cgi/content/full/j.jacc.2005.08.072v1

http://www.regionalpci-stemi.org/sitebuildercontent/sitebuilderfiles/nhaap-p12ekg.pdf

Pre-Hospital 12-Lead Electrocardiography Programs
A Call for Implementation by Emergency Medical Services Systems Providing Advanced Life Support—National Heart Attack Alert Program (NHAAP) Coordinating Committee; National Heart, Lung, and Blood Institute (NHLBI); National Institutes of Health
J. Lee Garvey
Heart Disease and Stroke Statistics--2004 Update. American Heart Association.
2. National Heart Attack Alert Program Coordinating Committee. 60 minutes to
treatment working group. Emergency department: rapid identification and treatment
of patients with acute myocardial infarction. Ann Emerg Med. 1994; 23:311-329.
3. Yusuf S, Collins R, Peto R. et al. Intravenous and intracoronary fibrinolytic therapy
in acute myocardial infarction: Overview of results on mortality, reinfarction and
side effects from 33 randomized controlled trials. European Heart Journal
1985;6:556.
4. Cucherat M, Bonnefoy E, Tremeau G. Primary angioplasty versus intravenous
thrombolysis for acute myocardial infarction (Cochrane Review). The Cochrane
Library, Issue 1, 2004. Chichester, UK: John Wiley and Sons, Ltd.
5. DeLuca G, Suryapranata H, Ottervanger JP, Antman EM. Time delay to treatment
and mortality in primary angioplasty for acute myocardial infarction: every minute
of delay counts. Circulation 2004;109:1223-1225.
6. Armstrong PW, Collen D, Antman E. Fibrinolysis for Acute Myocardial Infarction.
The future is here and now. Circulation 2003;107:2533-2537.
7. Boersma E, Maas AC, Deckers JW, Simoons ML. Early thrombolytic treatment in
acute myocardial infarction: reappraisal of the golden hour. Lancet 1996;348:771-
775.
8. Fibrinolytic Therapy Trialists’ (FTT) Collaborative Group. Indications for
fibrinolytic therapy in suspected acute myocardial infarction: collaborative
overview of early mortality and major morbidity results from all randomized trials
of more than 1000 patients. Lancet 1994;343:311-322.
9. Personal communication, Ms. Edna Stoehr, National Registry of Myocardial
Infarction.
10. Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman
JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL,
Sloan MA, Smith SC Jr. ACC/AHA guidelines for the management of patients
with ST-elevation myocardial infarction: a report of the American College of
Cardiology/American Heart Association Task Force on Practice Guidelines
(Committee to Revise the 1999 Guidelines for the Management of Patients with
Acute Myocardial Infarction). 2004. Available at
http://www.acc.org/clinical/guidelines/stemi/index.pdf. [Executive Summary print
version published in the J Am Coll Cardiol, August 4, 2004 issue, or Circulation,
August 3, 2004.]
September 1, 2004—Preliminary Draft for the NHAAP Coordinating Committee
9
11. Dracup K, Moser DK,




Prehospital 12-lead ECG diagnostic programs

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