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Here's a great case submitted by "Phil"… As usual, some details have been changed to preserve patient confidentiality.
It's 9 am, and you and your partner are called to an apartment complex for a 46 year old female, injuries from a fall which occurred the previous night. You arrive to find the woman seated in a chair, in some obvious distress. She appears pale and diaphoretic. You ask about the incident, and she tells you that at 11pm last night, she lost her footing on the stairs and fell, bruising her arms and shoulders. She denies hitting her head or any LOC, but is unsure how many stairs she fell down. She considered her injuries "minor".
You ask why she called this morning, and she tells you that her arms and shoulders are still sore, and she awoke at 8am feeling "very weak and sick", with nausea and one episode of vomiting. Your physical exam reveals only minor bruising, although her pulse feels a bit slow. She denies any chest pain or shortness of breath.
Her history is significant for Asthma and Type 1 Diabetes.
Her vitals are as follows:
Meds: Albuterol, Insulin
You put her on the monitor, and acquire a 12 lead:
The patient vomits again, as you begin transport… Enroute, you capture another 12 lead:
***UPDATE***
12 Lead with V4R has been added:
What do you think is going on with this patient?
How would you treat her?
EMS 12-Lead podcast – Episode #1 – Syncope and sudden death in student athletes.
Podcast: Play in new window | Download
Tom Bouthillet, David Baumrind and Christopher Watford are joined by Dr. John Mandrola from the Dr. John M blog. We discuss sudden death in student athletes, the controversy surounding the prescreening of student athletes, the need for AEDs in the schools, abnormal ECG findings that indicate higher risk, and the EMS evaluation of syncope patients in general.
Related content from EMS 12 Lead:
13 year old female CC: Syncope
37 year old male CC: Unconscious (syncope in an endurance athlete)
From the Pedi-U podcast:
Done Fell Out! Pediatric Syncope
From the Dr. John M blog:
Screening seemingly healthy young athletes?
The feasibility of routine ECG screening of athletes?
Related media
See also:
The Ongoing Controversy Over Screening Young Athletes With ECG – The Wall Street Journal Health Blog
Experts create "cook book" for interpreting young athletes' ECGs – heartwire
Doctors frequently make mistakes when interpreting young athletes' ECGs – heartwire
Accuracy of interpretation of preparticipation screening electrocardiograms. J Pediatr 2011 Jul 9
Interpretation of the Electrocardiogram of Young Athletes. Circulation. 2011;124:746-757 (subscription)
How Important Is the Electrocardiogram in Protecting and Guiding the Athlete? Circulation. 2011;124:669-671 (subscription)
Here is the conclusion to 47 year old male CC: Crushing chest pain.
You may want to go back and read the original case presentation to see how we got to this point.
When we left off we had this rhythm on the monitor and surprisingly the patient was conscious and talking!
As usual there was an excellent discussion in the comments.
I certainly agree that the first step is to check the leads. I've seen artifact mimic VF before! When I worked in the Critical Care Stepdown Unit as a cardiac monitoring technician this would sometimes happen when a patient brushed their teeth.
However, this time it was the real McCoy (hyperlinked explanation of this idiom for my international friends).
However, several features point away from Torsades de Pointes.
The rate of TdP is typically in the 150 – 300 range. A QTc of 447 while technically prolonged is still < 500 ms which is generally considered to be "safe".
It seems to go against everything we've been taught but could this patient have been conscious with VF on the monitor?
The answer is "Yes!" There are two reasons for this.
First, the onset of VF is often course and slow (relatively speaking). A ventricular rate of 375 is a lot different from a ventricular rate of 720. We like to think of VF as if it's all the same and it usually is from a treatment standpoint. But there is quite a lot of variability as I'm sure anyone who has worked on VF detection algorithms could tell you.
The second reason is that forward blood flow continues for several minutes after the onset of cardiac arrest. That's because there is a pressure gradient between aortic pressure and central venous pressure.
This chart from a white paper on the LUCAS device helps illustrate the point.
This is a busy chart but you will note that it takes several minutes for aortic pressure and central venous pressure to merge together after the onset of VF.
Mark Glencorse over at the (retired) 999Medic.com blog presented another case of transient VF where we had the same lively debate as to whether or not we were dealing with Torsades de Pointes.
Some of you are probably thinking, "It's not VF! It's polymorphic VT!" I will simply ask, isn't VF a form of polymorphic VT? At what rate does polymorphic VT become VF?
From a treatment standpoint it doesn't matter in this case because I'd treat both rhythms exactly the same. I'd apply the combo-pads and I'd give 2 g of magnesium sulfate while I was waiting to see if the patient lost consciousness. Tim Noonan (Scallywag Medic) will be disappointed in me for saying so but you really can't hurt a patient with MgSO4 and it might help.
In this case the treating paramedic didn't carry magnesium sulfate but he did apply the combo-pads.
About a minute and a half later the patient lost consciousness.
Now I think we'll all agree that the patient is in VF and we'll also agree on the treatment!
After another 2 cycles the patient was shocked back into a perfusing rhythm. Interestingly, the patient "woke up" several times during chest compressions.
The patient regained consciousness after return of spontaneous circulation.
Another 12-lead ECG was captured.
Now we're back where we started! (Okay, it's a little worse.)
Advanced notification was given to the receiving hospital and the cardiologist was waiting for the patient. He was taken directly to the cardiac cath lab where angiography revealed a 100% occlusion of the proximal LAD.
The lesion was successfully stented and the patient made a full recovery.
Congratulations to Phil, the Intensive Care Paramedic from Australia (and his crew) for a job well done!
Got an awesome case? Submit it to the EMS 12-Lead blog at ems12lead@gmail.com
If you've been following my fan page on Facebook you've probably already heard about the ACLS Review app by Limmer Creative.
To give you some background, Dan Limmer is a well known EMT textbook author with lots of street cred. You might recall his appearance on the EMS EduCast live from the conference floor at EMS Today 2011 in Baltimore.
His wife Stephanie (former Director of Internet Sales & Marketing for Lippincott Williams and Wilkins) brings to the table a lot of business eperience. You might call her the brains of the operation. (Kidding, Dan.)
Together they make up "Limmer Creative" and they are the creators of the well-known EMT Review app and Paramedic Review app for iOS and Android. Now they've branched out and created review apps for ACLS and PALS.
ACLS is a paramedic's "bread and butter". While many different allied health care professionals are required to hold an ACLS certification I'm aware of no other profession that spends as much time driving home mega-code simulations.
If you've "been around the block" a few times in the EMS profession you've probably seen a few different ACLS algorithms. I became a paramedic in 1995 so I've seen the 1995, 2000, 2005 and now the 2010 updates.
Unfortunately, the older you get (it pains me to say this) the harder it is to give up cherished beliefs. We did a lot wrong in the "old days" because frankly, we didn't know any better.
That's one reason I like the ACLS Review app by Limmer Creative. While I pride myself on being well-versed in the literature and I've done my best to help drive best practices in my own EMS system, I find that taking practice tests based on the 2010 AHA ECC Guidelines helps to eradicate previous versions of ACLS that are still swimming around in my mind.
Must be the old age!
I think I also like to challenge my knowledge of the guidelines. The truth is that I do very well on the tests but that's because I'm passionate about the topic.
The ACLS Review app offers 4 different tests. The way it works is you are given a test question (sometimes with a rhythm strip which I particularly enjoy) and then you are given some choices.
Take this screen shot for example:
You'll notice a little magnifying glass on top of the rhythm strip. If you like you can "tap" it and expand the rhythm strip so you can take a closer look.
For example here's a screen shot of a rhythm strip showing ventricular fibrillation.
Once you select and submit your answer you get a "check" when you're right and an "X" when you're… well… less than right.
However, my favorite thing about the ACLS Review app is that you also get a rationale.
I have found this app to be a very nice supplement to the 2010 AHA ECC guidelines. Sometimes I want to learn through trial-and-error (and not through painstakingly reading through the guidelines while my eyes glaze over).
At the end the ACLS Review app breaks down your score.
The graphical user interface is clean, the program is easy to use, and it has never "crashed" on me.
The ACLS Review app is reasonably priced at $3.99 (Apple iOS) (Android)
You can interact with Limmer Creative in the following ways:
So, now that my review is out of the way, it's time for an exciting announcement!
(Drum roll please.)
EMS 12-Lead is partnering with Limmer Creative to put together a 12-Lead ECG Challenge app!
I'm excited about the project and I'd like to thank Dan and Stephanie for appoaching me with this opportunity!
So keep your eyes peeled! This app will be coming soon to an Apple or Android app store near you.
See also:
ACLS Review App can help you master algorithms, prepare for ACLS Certification (iMedicalApps.com)
Here's an awesome case submitted by Phil, an Intensive Care Paramedic from Australia. Some minor changes have been made to ensure patient confidentiality.
EMS is called to a track and field event for a 47 year old male patient with chest pain.
On arrival the patient is found lying on the grass with a cold, wet towel on top of him. He appears pale and acutely ill. Otherwise he appears to be in excellent physical condition.
Past medical history: CAD, dyslipidemia, mild hypertension, stents x3 approximately 4 years ago
Medications: Numerous but not immediately available
Vital signs are assessed.
Breath sounds are clear bilaterally.
The cardiac monitor is attached.
A 12-lead ECG is captured.
A rhythm change is noted on the monitor.
The patient is still conscious.
What's going on with this patient?
What is your next move and why?
This is the discussion for 89 year old female CC: Sick. You may wish to go back and review the case.
To begin, lets review one of the 12 leads:
Many of you correctly identified this as a third degree block….however, the etiology of the block was at the time unknown, especially in light of the fact that the patient had no prior cardiac history.
Other confounding factors on her ECG were the huge and bizarre inverted T waves, and the very long QTc of 639!
So, we have a few decisions to make:
We would all agree that the patient is symptomatic, but is she stable? Clearly, under exertion, she is not. However, laying still on a gurney, is she?
While she is in your care, does she have:
What was notable right off the bat, was that the patient was mentating well and making a good pressure at 160/74. She was no doubt helped by at least two factors:
In any ACLS classes I've taken the question of stability is usually black and white. However, out in the field it is often not clear at all!
One major concern is if this was due to an ischemic event. In the face of an adequate junctional escape, do we really want to speed up the heart and increase the workload of the heart and O2 consumption? Pacing would do this, as would atropine.
The other major concern here was the very prolonged QTc. Was she at risk for sudden VT? Possibly.
After all this was considered, the crew decided she was "tolerating the rhythm". They elected to place combi-pads, in anticipation of her condition deteriorating, and provide supportive care (O2, IV, monitor). Vitals were monitored every few minutes, as was mental status. Because of the fact that she was tolerating the rhythm, and the concern the crew had of an ischemic event going on, the decision was made not to increase the workload of the heart via medication or pacing unless her presentation started to change.
But wait, what about that bizarre ECG?!
Many of you pointed out, correctly, that a neurogenic cause of those bizarre inverted T waves had to be considered even without evidence that the cause was neurogenic.
So I asked Stephen Smith, M.D. of Dr. Smith's ECG Blog for his impression of these ECG's, and here is what he had to say:
As for the T-waves, you have a classic EKG here: this is what is called a Stokes Adams attack. I have no idea why it produces these T-waves but I have seen this several times and it is described in textbooks. 3rd degree heart block, often associated with syncope, and with bizarre wide inverted T-waves and a long QT.
For a more in-depth discussion of giant T wave inversions, visit here.
Here is an example of the giant inverted T waves of a Stokes-Adams attack from this article:
Stokes-Adams attacks are frequently the result of ischemia. For more information on Stokes-Adams attacks, visit here.
Also, some pointed out the issue of the axis changing from one ECG to the next…
It is possible that the focus of the escape was changing locations, and equally possible that it was due to something else. While this may be interesting to note, it will not likely change our treatment of this patient at all.
At the hospital, her troponin level came back elevated. She was diagnosed with NSTEMI, and in addition was sent for immediate pacemaker implantation.
This is the discussion for 17 year old male CC: Syncope.
You may wish to go back and familiarize yourself with the details of the case.
Let's take another look at the 12-lead ECG.
It wasn't that long ago that I was trying to convince paramedics to perform 12-lead ECGs on chest pain patients.
I can still hear some of them saying things like:
Perhaps you've heard your own excuses.
Fast-forward to today and (at least in my EMS system) it's no longer debatable as to whether or not chest pain patients require a 12-lead ECG.
The new frontier is patients with syncope, general weakness, shortness of breath, etc.
In the first place patients with syncope, general weakness, or shortness of breath are sometimes experiencing acute STEMI (the anginal equivalents) and you've probably seen dozens of examples of each on this blog over the years.
On the other hand, sometimes they're experiencing complications associated with other problems that can often be identified with a 12-lead ECG if you know what to look for.
There were a lot of comments for this case that brought me back to the "old days" of hearing things like "it's not our job" or "we're not doctors."
Paramedics are not board certified emergency physicians. That's true and I have no quarrel with that statement.
That doesn't mean we shouldn't do our due dilligence prior to allowing a patient (or guardian) sign a "no treatment, no transport" form, or an AMA form, or whatever you call it in your agency.
Any refusal must be an informed refusal. That means it's incumbent upon you to obtain a careful history, perform a physical exam, assess vital signs, and when appropriate record other diagnostic tests like a BGL, SpO2, or an electrocardiogram.
From there you should engage the patient (or the patient's guardian) in a discussion about the risks associated with refusing care, and it's extremely lazy and dishonest to tell every patient, "You may die if we don't take you to the hospital." regardless of what the complaint is.
I live in a subtropical environment that gets very hot and humid in the summer. We see 2.25 million tourists a year. They're not used to the climate and syncope is a very common complaint.
Is syncope a potential warning sign of a fatal condition? YES!
Is syncope often benign? YES!
Can a paramedic be trained to tell the difference between a high-risk patient and a low-risk patient? YES!
If the paramedic is not trained to tell the difference between a high-risk and a low-risk patient then the paramedic should be on the phone with Online Medical Control explaining the situation. Perhaps that's not a bad idea regardless.
In this case:
However, the ECG does meet the voltage critieria (for adults) in the precordial leads. However, no P-wave abnormality and no "strain pattern" is present.
Since the patient was only 17 years old and appeared to be a very athletic young man the treating paramedic felt fairly certain this was a normal ECG.
However, this is one of those occasions where the ability to transmit the 12-lead ECG to the emergency department came in very handy.
The 12-lead ECG was transmitted to the on-duty ED physician who reviewed the ECG and agreed that the patient was very low risk.
The patient (and the patient's mother) were advised that nothing life-threatening was found in the evaluation, but that EMS wasn't giving this young man a "clean bill of health". They explained that EMS couldn't rule out all life-threatening causes of syncope in the field because we don't do blood work, we can't perform a CT scan, and that all diagnostic tests have a sensitivity and a specificity. In other words, it's entirely possible we're missing something. In addition, we're not doctors (that should please some of you).
A refusal was signed and the patient (and his mother) went back to their dinner. They were advised to call 9-1-1 again if they changed their minds or if symptoms returned.
In my opnion, this EMS crew did an outstanding job. If we're being completely honest about it we'll admit that some paramedics would have gotten on the radio and announced "false call" the moment the patient came outside and tried to cancel EMS.
How many of the rest would have been this thorough in their patient assessment?
In the last analysis the patient (or the patient's legal guardian) makes the decision as to whether or not the patient will be seen in the emergency department when the patient possesses present mental capacity. I've seen plenty of cases where paramedics have manipulated patients into refusing care out of sheer laziness or some kind of misguided attempt to spare the emergency department from seeing a patient who was a "non-emergency" in their opinion.
If find that to be appalling but that clearly wasn't the case here.
As a final thought George W. Bush experienced a similar fainting when he choked on a pretzel while watching a football game back in 2002. Remember that one? I still remember the detailed animations on the nightly news that explained how choking and coughing stimulated the vagus nerve.
It's a snowy afternoon, when you and your partner are called to a local doctor's office for an 89 year old female with "flu-like symptoms", including nausea and vomiting over the past two days.
You walk into Room 2, and find a sick looking woman lying back on the exam bed…She is alert and oriented, and denies any chest pain or shortness of breath…but her color appears grey. She is not diaphoretic, and also denies any numbness or tingling anywhere. She tells you that as long as she lays still, she feels ok, but every time she gets up to walk even a few feet she gets dizzy, short of breath, and nauseous.
She says " I didn't want to go to the doctor, but my friends forced me to because they said I looked ill."
She tells you she's generally in good health, her only hx being very bad hypertension, for which she takes Cozaar and Atenolol. Because of the nausea and "retching", she has not been able to take her meds for the couple of days.
you obtain the following vital signs:
The PA hands you the following ECG they acquired 30 minutes ago:
You apply your cardiac monitor and acquire the following 12 lead:
Enroute to the hospital, you acquire one more 12 lead:
*** UPDATE***
By request, here are the computerized numbers from the last ECG:
How do you interpret these ECG's?
is there anything else you'd like to know?
How will you treat this patient and why?
1.) How long have you been working with AHA Mission: Lifeline? Do you enjoy your job?
I have been with MLSD (Mission: Lifeline South Dakota) since September 16, 2010. My background prior to that is in EMS and as an RN in cardiology and Emergency Department nursing-all here in South Dakota.
I seriously with 100% truthfulness love this job. I have the opportunity to distribute an $8.4 million grant to the people of South Dakota to establish an ideal STEMI system of care in a very rural setting. I work with each of the 133 ambulances and 50 hospitals in building this system of care. We are putting at least one 12-lead monitor (Phillips, Physio-Control, or Zoll) in each of the 133 ambulances, as well as implementing Lifenet in each of the 50 hospitals. It is a little like being Santa Clause- with a catch- that you have to use the equipment and be an active participant in the system of care.
2.) How many PCI-hospitals are there in South Dakota and how are they distributed?
I have attached a map to outline.
The population of South Dakota is about 750,000. South Dakota is 76,000 square miles with 6 PCI facilities:
The 3 in Sioux Falls represent two health systems so that’s why it only looks like 2 in Sioux Falls.
The entire NW corner of the state does not have a PCI capable hospital up to as far away as almost 200 miles. In addition, South Dakota only has 4 helicopters. 1 in Rapid City, 1 in Aberdeen, and 2 in Sioux Falls. We have a large area of the state that can only be covered by fixed wing (which we have 2 of-both in Sioux Falls) or ground ALS transport.
3.) Have you found that most urban areas have prehospital 12-lead ECG programs in place and do they transport STEMI patients directly to PCI-hospitals?
When we began this process with the 133 EMS agencies of South Dakota we found the following breakdown:
Keep in mind the agencies that are ALS are primarily a part time, volunteer ALS service and up to 80% of the time they are BLS.
The 8 agencies that had 12 leads and were transmitting prior to this process did not go directly go a PCI center. 6 did and 2 are located in very remote areas and were a part time ALS service. Bypassing their critical access hospital could have means as long as a 2 hour transport time. They were going to the nearest facility and calling for a helicopter or an ALS intercept.
4.) South Dakota has a lot of rural areas and one imagines a lot of volunteer BLS rescue squads and Critical Access Hospitals. In areas where STEMI numbers are low have you seen a reluctance to give thrombolytics (or arrange for transfer) without a cardiology consult?
YES! Note the capital letters and emphasis on YES. Part of the process of building or STEMI system of care is that we have a state wide protocol for administration of lytics in the non-PCI centers. The feedback has frequently been from the non-PCI centers:
5.) How has AHA M:L been working to help incorporate rural areas into regional systems of care?
At our statewide Mission: Lifeline task force we have representation from all size hospitals and EMS agencies. The reality is that our PCI centers are doing a great job, our focus needs to fall not only to EMS but the hospitals that reside outside of the 30 mile radius of our PCI centers. We involve representation from Critical Access hospitals, volunteer EMS, as well as our PCI centers. We also have a quality and education subcommittee that allows a strong voice from those smaller, rural facilities.
6.) We just saw a press release that indicates every ambulance in North Dakota will be outfitted with 12-lead ECG monitors. Can you tell us anything about that? Is something similar happening in South Dakota?
The North Dakota project will be very similar to South Dakota. Lead funder is The Leona M. and Harry B. Helmsley Charitable Trust, which is providing two-thirds of the total with a grant of $4.4 million. The State of North Dakota has committed $600,000, and a combined $1.3 million will be contributed by North Dakota’s largest healthcare systems:
The Dakota Medical Foundation is supporting the initiative with a $100,000 grant, and the Otto Bremer Foundation has also committed $100,000 to Mission: Lifeline.
Minot, North Dakota already has a strong rural STEMI system with transmission of 12 leads from 12 rural EMS agencies, so while they are not putting in quite as many 12 leads as South Dakota, the models will be very similar. We face a lot of the same hurdles in regards to volunteers, miles, etc.
The grant allows for education of all EMT’s in the state in the “Learn Rapid STEMI ID” module put forth by the AHA, as well as education for all non-PCI center hospitals. In addition a statewide task force comprised of physicians, nurses, EMS, legislators, payors, administrators, etc will meet to direct this project- same as South Dakota. The ultimate goal for both of our states is simple — that we decrease time from calling EMS to reperfusion whether that is primary PCI or lytics.
North Dakota has just hired a Mission: Lifeline director that will start next month.
7.) Change is always hard and often comes with growing pains. What are some of the most difficult challenges you've had to overcome to help shorten treatment intervals for acute STEMI in South Dakota?
For the most part our partners have been very engaged and have realized that an intervention they do in the field (12 leads) can be the difference in life or death for our STEMI patients. Quite frankly, distributing a 12 lead monitor that could cost up to $25,000 is something these EMS agencies would never have been able to afford. That part makes it an easy “sell”.
The reality is that we are about 75-80% volunteer and we are now asking them to do/learn another thing for no pay. There is a fear out there that they could hurt someone by doing a 12-lead. I frequently reference that we are not asking to turn the mailman into a cardiologist — our first step is to put the patches on and push the buttons. The monitor itself can be overwhelming for a volunteer EMT that only runs 2-4 calls/month.
We have provided education to 1600 EMTS thus far and it has all been done in their local communities by an ALS partner from a neighboring community that they are already familiar with-that has helped immensely.
8.) Has anything special been done to help educate EMS personnel with regard to 12-lead ECG interpretation? How have they embraced that education and training?
We have developed a 4 hour education program that is being deployed by 22 “super users” from across the state (21 paramedics and 1 EMT-I). This education is done in their hometowns to decrease travel time. The content does go fairly deep in the process of anatomy, physiology and looking at 12 leads- however our main basis is to get correct lead placement and to transmit to their local hospital where they are transporting the patients. This education process will repeat for each of the 3 years of the grant.
9.) Any problems with "false positive" cardiac cath lab activations? What kind of feedback is given to EMTs, paramedics, nurses and physicians who take part in regional systems of care?
Not so many problems with false activations. We of course had one right away after we went up that was given back to me as “constructive criticism” but I rebut with the fact that in South Dakota we over triage trauma patients up to 50% of the time and as long as the staff believed they were doing what was right for the patient at that time it’s ok.
Feedback loop — that is the million dollar phrase right now. Having worked most of my career in the hospital- we have not done a good job of letting EMS (especially our volunteer services) know how they are doing. Our statewide task force is working on a universal feedback loop that will go back to not only the hospitals but the EMS agencies as well.
Two of 6 PCI centers currently have a feedback loop to the transferring in hospital that they send within 24 hours-but as you know that frequently does not get to the EMS agencies. It has come through loud and clear that involving EMS in the feedback is the one key element most of us are missing.
10.) Do you have any words of wisdom for states that are just getting started?
Be Persistent. Believe in it. Utilize your resources. Make friends with your EMS partners. (I mean that-sometimes we need to put the ER, Cath Lab, and EMS in the same room with some beverages and just let them become friends…..) Find a champion. I don’t care if it is the smallest EMS agency or one of the largest PCI centers-somewhere in that agency is someone who will help you carry the torch.
I have been told that this is impossible many times. My answer becomesm, “You will have to be one of those we just have to prove wrong”. Once you get a save, you are able to put many of those skeptics to rest.
Physio-Control is on the verge of launching a new product that could be a game changer for the care of STEMI patients, especially in rural areas.
It's called ReadyLink 12-Lead ECG and it will allow BLS personnel to capture a 12-lead ECG and transmit the ECG for off-site interpretation using the LIFENET system.
This is important because right now in the United States there are a lot of rural areas that have been excluded from regional systems of care because they don't have the ability to capture 12-lead ECGs.
As a result STEMI patients are not receiving timely reperfusion, and as well all know by now, longer the time-to-reperfusion the higher the mortality!
Last week I was given an exclusive interview with Cees Verkerk and Erik Denny from Physio-Control to talk about the device. I was also given permission to give the readers of the EMS 12-Lead blog a "sneak peak" prior to the product launch.
Here's what I found out:
In the past couple of years I have been made aware of a handful of volunteer or BLS EMS agencies that have been equipped (through grants or charitable donations) with Lifepak 12s or Lifepak 15s so they can acquire and transmit 12-lead ECGs.
While this is certainly commendable the cost can be prohibitive.
As regional systems of care for acute STEMI continue to be implemented across the country with help from organizations like the American Heart Association's Mission: Lifeline, it's easy to see how the ReadyLink 12-Lead ECG will nicely complement the LIFENET system by tying in the rural areas.
After all, they have heart attacks, too!
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