Here are the truths i got from these answers:)   " have little doubt...and this has been proven in the literature, that the 2-4 minutes spent doing a 12 lead can significantly decrease door to time to reperfusion."   There is actually no proof. Only in areas where there is telemetry has this bypass ER situation happened. The literature is actually very much against EMS. Even something as solid as pre hospital intubation hasent been proven to cause or increase positive outcomes in pre hospital. There has even been numerous studies that have shown that patients who take taxies or drive POV do better than call 911 as they get to the hospital faster. Personally, i think it has more relation to the people doing the studies than actual truth, but thats what research has given us so far. Sad i know, i went looking and came up empty handed.   "Does the syncope patient always receive aspirin and get transported to a hospital capable of cardiac cath?? Only if the 12 lead shows an MI....Same for the diabetic with diaphoresis or the female who has been feeling weak and tired. What about the tachycardias? Isn't there utility in figuring out the rhythm when a 12 lead is available?? I definitely think so."   Well actually, they should all be taken to a cardiac facility. 12 lead EKG has been shown to only be sensitive 40-50% of the time to MI. That being the case, we should always assume the worst and utilize resources appropriately. I agree with you, there is utility, but how does it really change treatment? Diabetic, take an accucheck give fluid, tachy give some fluid. Are they stable or unstable? If unstable cardiovert, IF SVT and stable give adenocart, if stable and unknown  tach monitor. We have been doing this for years. I know it sucks but you see where im going ;)    My feeling then and now is that EMS (ALS specifically) provides a valuable role in the chain that leads to positive patient outcomes. EMS needs to expand and include such things as suturing in the field for superficial Lac's, ability to treat and release (such as adenosine monitor and release, d50 monitor and release etc etc). Unfortunately, the power resides with the physicians and they arent, as a whole, responsive in the least bit. The downside is we only have ourselves to blame. There are paramedics who volunteer, a nice thing, but it degrades the profession by suggesting we would do it for free so why pay us what we are worth? This causes us to attract the wrong people often and an inability to retain the quality ones. Many paramedics see EMT-P as a way to be more marketable to a fire dept. where they will make more money and be a fireman not because they are interested in paramedicine. We still allow 6 month paramedic courses which often cant even manage a good cookbook paramedic let alone a critical thinker. These are but a few examples. We have all seen them.   I dont know what the fix is, but i do know more people in the field that i wouldnt want to have RSI, 12 lead decision making capability and thrombolytics because they are uninterested cowboys, not patient centric. I dont intend to offend anyone, this is just the situation at hand which needs to be resolved before moving ahead can happen.   Mike MacKinnon mmackinnon@... -------Original Message-------   From: David Rand Date: 05/30/05 21:44:39 To: ekg_club@yahoogroups.com Subject: RE: [ekg_club] ACC/AHA Clinical Competence Statement on Electrocardiography andAmbulatory Electrocardiography   Hi Mike, I appreciate your point and agree that there is plenty of gee whiz info out there.. we don't see enough zebras in EMS to be comfortable with them. And in most cases, the primary point of EMS is to get patients rapidly to the hospital. However, we cannot neglect our role in preparing the hospital for the patient. I have little doubt...and this has been proven in the literature, that the 2-4 minutes spent doing a 12 lead can significantly decrease door to time to reperfusion. Additionally, as has been pointed out already, a 12 lead can significantly impact destination decisions, which again significantly impact type of treatment (thrombolysis vs ptci) and time to treatment.    The twelve lead also plays a role in appropriate prehospital treatment of patients without classic chest pain. Does the syncope patient always receive aspirin and get transported to a hospital capable of cardiac cath?? Only if the 12 lead shows an MI....Same for the diabetic with diaphoresis or the female who has been feeling weak and tired. What about the tachycardias? Isn't there utility in figuring out the rhythm when a 12 lead is available?? I definitely think so.   Thanks for fighting the good fight...and for not forgetting your EMS roots. Dave Rand EMT-P Mike MacKinnon <mmackinnon@...> wrote: While i agree with you, the problem remains that it is simply geewhiz info. Truly, pre hospital 12 lead will not change your Tx. I have tried to lobby for it in my area and got gobsmacked by Cardiologists, friends of mine even. At the end of the day it doesn't change treatment pre hospital. So if that is the case, then why muddy the waters.   Their argument was actually very convincing. When you add extra information to a service which is centered around getting to the hospital as fast as possible, what do you do? You add time to making decisions. In reality this is very true. The fact is, after years and years of being in EMS, i have learned one very salient truth. Most people (80% or more) in EMS have absolutely no interest in learning a damn thing. Out of the 20% left 10 % already think they are doctors, we commonly refer to them as cowboys. Lastly, you have the 10% (which are right here on this list) who actually take their job very seriously and extend their knowledge far beyond expectation. If the percentages were different i'd agree, but think about it for a moment, and the average people you work around, and it becomes pretty clear. I have worked in Canada, here in the states and been at a multitude of conferences where the exact same sentiments are expressed.   My feeling is that if your really interested in learning about 12 lead EKG's and how to properly interpret them, goto a course at your base hospital. Most hospitals offer basic and advanced courses. Buy the books and read them and participate on this list. The truth is, no pre hospital service will see the 'Zebra' EKG's enough to feel confident in their Dx. It is just like any skill, you dont use it and practice alot, you lose it. The things i see in hospital after i became a critical care (ICU/ER/Flight) nurse blew me away. We all know the EMS 1%er law. 1% of your patients are actually sick enough to need you, the other 99% use you (to one degree or another) as a taxi service. I know this is different based on patient age v pop. but we all know this to be true.   Another perfect example is FAST scan hand held ultasound for the Helicopter service. Everyone wants a new toy, hell so do i, however, How does it change my practice. It dosent change a thing at all. So what if i find a liver lac, blood in the abdomen? Any physician that took MY word for it would be one soon headed to court.   The only utility for 12 lead pre hospital is for it to be faxed/sent to an on call cardiologist/Er doc to decide if the patient should go straight to cath lab.   I know this is controversial, and i know we all want toys however, put aside your emotions for a moment and think about what i have said. I had to do the same thing, and i know its hard. Then, pretend someone is trying to justify it to you, what level of expectation would you have for it? What would you want as proof this was not only interesting training, but would change patient outcomes and people would actually learn it properly? We still have ALOT of people cricing patients who can be bagged cause they couldn't get the tube.   Bring on the arguments ;)   Mike MacKinnon mmackinnon@... -------Original Message-------   From: KavinIN@... Date: 05/30/05 14:08:25 To: ekg_club@yahoogroups.com Subject: RE: [ekg_club] ACC/AHA Clinical Competence Statement on Electrocardiography andAmbulatory Electrocardiography   Y'know, while I'm tired of every Tom, Dick, Harry, and Jane coming out with new alphabet courses, I think an ECG course would be wonderful.  We've most likely had the experience where you present a strip or 12 lead to a group of people and you get a handful of responses.  Whether it is something manageable in the field or not, does it matter?  Should we have that knowledge or not?  If not, we are advocating the "if I can't do anything about it, I don't need to know about it" mindset; if we should have the knowledge, are we wasting the Provider's time having them assess for low voltage in a 350# COPDer? Each service needs to have a true EKG guru, IMO.  One that can remediate other Providers, effect training programs, work with the MDs, etc.  Due to Dr. Garcia's efforts, and no offense to you whom are very educated on these matters, I only want to learn EKGs from a cardiologist--I've found that even the ER doctors don't quite have it all right (hence having the cardiologist on call)... when our system goes to 12 leads, the educational experience should be interesting, to say the least... people are already calling IVCDs in narrow complexes, BBB in Lead II (and even when narrow), can't print in diagnostic mode, etc... the learning curve will be *huge*. But, do we stop at elevation/depression, or do we go past the stuff that is emergent, and teach things that will help the provider really understand what the printout is saying?  Perhaps we need a Basic 12 lead certification and an advanced certification...? -- Jon Kavanagh NREMT-P "...to obey is better than sacrifice."  1 Samuel 15:22b __________________________________________________________________ Switch to Netscape Internet Service. As low as $9.95 a month -- Sign up today at http://isp.netscape.com/register Netscape. Just the Net You Need. New! Netscape Toolbar for Internet Explorer Search from anywhere on the Web and block those annoying pop-ups. Download now at http://channels.netscape.com/ns/search/install.jsp The EKG Club moderators (Nick and Tom B) wish to thank you for your participation! Our two year anniversary is coming quickly! We will soon be adding the more popular and educational cases to http://www.ekgclub.com but in the meantime please feel free to post them here. If you need assistance in posting a case, you may send it to either Nick or Tom B. May your days be filled with tachycardias and pacing!   The EKG Club moderators (Nick and Tom B) wish to thank you for your participation! Our two year anniversary is coming quickly! We will soon be adding the more popular and educational cases to http://www.ekgclub.com but in the meantime please feel free to post them here. If you need assistance in posting a case, you may send it to either Nick or Tom B. May your days be filled with tachycardias and pacing! No virus found in this outgoing message. Checked by AVG Anti-Virus. Version: 7.0.322 / Virus Database: 267.3.0 - Release Date: 5/30/2005 The EKG Club moderators (Nick and Tom B) wish to thank you for your participation! Our two year anniversary is coming quickly! We will soon be adding the more popular and educational cases to http://www.ekgclub.com but in the meantime please feel free to post them here. If you need assistance in posting a case, you may send it to either Nick or Tom B. May your days be filled with tachycardias and pacing!

The EKG Club moderators (Nick and Tom B) wish to thank you for your participation! Our two year anniversary is coming quickly! We will soon be adding the more popular and educational cases to http://www.ekgclub.com but in the meantime please feel free to post them here. If you need assistance in posting a case, you may send it to either Nick or Tom B.

May your days be filled with tachycardias and pacing!


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