If time is muscle, what's taking so long?

That’s that tag line of a tremendous article that appeared in the March 2007 issue of Emergency Medical Services entitled Out-of-Hospital STEMI Alert by David Jaslow, MD, MPH, EMT-P, FAAEM. I think the tag line sums up the frustration many of us “STEMI activists” feel when our prehospital 12 lead ECG programs flounder.

Here are some of the highlights:

“One of my favorite citations to point out how ridiculous it is that we still don’t have widespread capability to diagnose patients with STEMIs, institute aggressive EMS care and move them toward cath labs is from the premiere episode of Emergency! This show depicted what was actually happening in the early 1970s as Los Angeles County implemented one of the first ALS systems in the country. If you listen carefully to the discussion between Gage and DeSoto during their tour of the new Squad 51 (paramedic responder/light rescue vehicle), there’s distinct mention that the Datascope cardiac monitor is capable of acquiring and transmitting full 12-lead ECGs…

“EMS personnel must be appropriately trained in the acquisition, interpretation and/or transmission of the 12-lead ECGs (which should take place in initial paramedic education courses) and must have the technology to do it all. As well, there must be a robust CQI system in place to identify and correct deficiencies in the system […] Options for ECG interpretation include training paramedics to read the study on their own and make a diagnosis without physician backup (no transmission), diagnosing suspected acute MIs and transmitting only those to a base station for physician overread (selected transmission), or mandating transmission of every 12-lead ECG acquired without any paramedic interpretation. Intense education must also be focused on the concept of transport to the closest appropriate facility, not just the closest facility…”

“[T]he net needs to be cast wide when deciding who needs a 12-lead ECG other than the standard patient who actually complains of chest pain. Patients who are also candidates include those with shortness of breath, abdominal pain, weakness and general ill feeling for which there is no obvious noncardiac explanation…”

“Many urban EDs are in crisis due to overworked staff members, staffing deficiencies, overcrowding, lack of emergency medicine-trained physicians and nurses credentialed as CENs, poor throughput and a host of other factors. Poor staff morale can create a culture of apathy and indifference that’s counterproductive to attempts to improve patient care-something that requires effort on the part of every individual. I have witnessed paramedic-acquired ECGs thrown in the trash, detailed EMS reports of critically ill patients with potential STEMIs ignored and other hostile EMS/hospital interface issues…”

Sound familiar? Mine used to get thrown on the little silver table next to the patient’s bed (a process Ivan Rokos, MD now refers to as the “silver table treatment”).

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