A recent story from the Canadian Press talks about the international STREAM study (Strategic Reperfusion Early After Myocardial Infarction).
“It’s widely recognized that the faster you treat a heart attack, the better the outcomes,” says Dr. Warren Cantor, a cardiologist at Southlake. “You can preserve heart muscle and increase a patient’s chance of survival by opening the artery quicker.”
“Furthermore, we now realize you can save approximately one hour if you diagnose the heart attack in the ambulance as opposed to in an emergency department.”
I certainly can’t disagree with that.
So far, more than 400 patients worldwide have been included in the STREAM protocol, which compares two treatment strategies.
The first involves giving a clot-busting medication in the ambulance, followed by artery-opening balloon angioplasty within 24 hours, while the second has a patient undergoing angioplasty within three hours, without a prior clot-dissolving drug.
This study will not resolve the question as to whether or not primary PCI with prolonged transfer times is superior to fibrinolytic therapy followed immediately by PCI.
Now the really interesting quote.
“So what we’re looking at is whether patients may benefit by getting the clot-busting medication in the ambulance,” explains Cantor. “And in order to do that, you can’t rely on a paramedic interpreting the ECG. A physician really has to confirm the heart attack.”
The obvious question is, why can’t you rely on a paramedic interpreting the ECG?
9 Comments
I've found the more you say something, the more you believe it is true.
Why are so many good studies ruined by something someone's tried to prove by assertation?
According to this thread at EMT City there was a backlash from the paramedics when they read that quote in the paper.To the doctor's credit, he apparently replied with a 3 page explanation.It's possible he simply chose his words poorly.Tom
Another thing to perhaps consider is that Canadians use the term Paramedic differently that Americans do. Paramedics fall under multiple categories in Canada – from Primary Care Paramedics to Advanced Care Paramedics. From what I can tell, the PCP is more like an EMT-Intermediate (or EMT-Advanced in the new lingo) in the US.Perhaps the Doc has these levels confused or something. I wouldn't be surprised if he meant, "you can't rely on an EMT/Ambulance Driver interpreting the ECG".
MIFL -Excellent point! Tom
On the other hand, I'm curious to know what the minimum requirement is to be on an ambulance in Canada. I'm certain it's not a 100 hour crash course in first aid like it is here in the U.S.Tom
Here in Ontario we don't have 'ambulance drivers' or emt's. the absolute minimum requirement is that one is a primary care paramedic (which is a two year college program). In the past there have been services (particularly rural ones) that have had volunteers that were classified as Emergency Medical Attendants (EMAs) however, these have been completely phased out. I can't really speak for other provinces.
dsheerin -Thanks for the clarification!Tom
As a follow up, the letter the cardiologist wrote the YREMS medics is available here. http://www.cepcp.ca/main/paramedic/2009%2011%20Dr.%20Cantor%20Letter%20of%20clarification.pdf