Things that make you go hmmm

It seems incredible that we can email a photograph around the world, but we haven't yet found an easy way of transmitting an ECG to a nearby hospital.

– Ivan Rokos, MD to heartwire [1]

Question: What's the incentive for industry to invent a simple, cost effective method for transmitting the prehospital 12 lead ECG to the hospital?

8 Comments

  • Sonnet says:

    You have a nice blogI invite you to mine:(Broken heart syndrome)http://tabibqulob.blogspot.com/2009/04/cardiocerebral-resuscitation-ccr.html

  • Tom B says:

    Thank you! I enjoyed your post on cardiocerebral resuscitation.Tom

  • Rogue Medic says:

    I do not see the need to fax/email 12 leads. As with medical command permission requirements, this seems to be another thing to interfere with continual patient assessment. This is just one more thing to delay treatment. If the goal is to get the patient to the cath lab as soon as possible, why aren’t we removing things that delay arrival in the cath lab?

  • Tom B says:

    I agree with that in principle, Rogue Medic. But then EMS has to step up to the plate and develop the necessary competence to accurately interpret the 12 lead ECG. It’s that simple.Tom

  • Rogue Medic says:

    The same medical directors have EMS make decisions about trauma alerts and helicopter flights. How is this different? Should we be putting 12 lead monitors in the hands of people who cannot competently use them?

  • Tom B says:

    Rogue Medic – What is different is that trauma has always been a core part of the EMT/paramedic education. Even so, I see mistakes made with the triage of trauma patients on a semi-routine basis.My first choice would be enhanced paramedic education and training (and I’m trying to do my part). Unfortunately, there’s not broad agreement as to what a paramedic “needs to know”. In my view, a paramedic ought to be trained to interpret a 12 lead ECG at a very high level (axis determination, bundle branch blocks, tachycardias, STEMI, STE-mimics, AMI in the presence of baseline abnormalities, electrolyte abnormalities, etc.).Until that is made a part of the paramedic’s core education, I don’t have a problem with ECGs being transmitted for physician interpretation if it leads to faster reperfusion for the patient.After all, it’s not about us. It’s about them. As a parting thought, some EMS systems still don’t have 12 lead monitors, and some don’t even have paramedics! Are you okay with EMT-basics transmitting the 12 lead ECG if it means bypassing the local community non-PCI hospital and going straight to an appropriate medical facility?Tom

  • Rogue Medic says:

    Tom B,What is different is that trauma has always been a core part of the EMT/paramedic education. Even so, I see mistakes made with the triage of trauma patients on a semi-routine basis. Maryland acts as if the helicopter is there to make up for any lack of training of the paramedic, or to make up for the lack of a medic. For them it is not just semi-routine. My first choice would be enhanced paramedic education and training (and I’m trying to do my part). Unfortunately, there’s not broad agreement as to what a paramedic “needs to know”. We don’t need to know what we need to know. It’s a secret.In my view, a paramedic ought to be trained to interpret a 12 lead ECG at a very high level (axis determination, bundle branch blocks, tachycardias, STEMI, STE-mimics, AMI in the presence of baseline abnormalities, electrolyte abnormalities, etc.). I agree.Until that is made a part of the paramedic’s core education, I don’t have a problem with ECGs being transmitted for physician interpretation if it leads to faster reperfusion for the patient. Does adding this extra step really lead to faster reperfusion? After all, it’s not about us. It’s about them. I agree. Remember that medical command permission requirements are obstacles to care for the patient. The same as any other unnecessary step.As a parting thought, some EMS systems still don’t have 12 lead monitors, and some don’t even have paramedics! Clearly, if you do not have 12 leads, you cannot reasonably activate the cath lab. OTOH, neither can the ED physician based on the transmitted strip. Unless it in diagnostic mode.Are you okay with EMT-basics transmitting the 12 lead ECG if it means bypassing the local community non-PCI hospital and going straight to an appropriate medical facility?I may be misunderstanding what your point is. Why would basic EMTs have 12 lead capability? I do not know of any place that gives 12 leads to basic EMTs, do you?I think that it is the responsibility of the medical director to make sure that the medics know how to interpret 12 leads. Teaching medics to interpret 12 leads, but then requiring this extra step, or extra steps, is only interfering with the care and assessment of the patient.

  • Tom B says:

    Yes! I have heard of EMS systems that allow EMT-basics to capture and transmit 12 lead ECGs to the ED (without paramedics). I’ve also discussed this with Dr. Rokos and it’s come up at the AHA-ML EMS Advisory Committee meetings in SC.Tom

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