Dear Adrian,
American Heart Assoc Guidelines (1999) refers to 20 min on scene for Acute Coron Syndromes, but also recommend taking a pre-hosp 12 lead ECG. We are averaging 15. Taking pre-hosp 12 lead is mainly used to determine who should go in on blues - 2,000 MIs per year out of 20,000 chest pains per million. Also for facilitating direct entry to location in hosp which delivers thrombolysis and chest pain triage nurse on-stand-by. Generally tend to cannulate and take BP en route or not at all. For pre-hosp thrombolysis, we try to aim for 30 min Call to Needle, and average about 32 on last audit.
PHTLS talks about platinum 10 minutes on-scene, for non-entrapped, which is very achievable.
We are really interested in time to definitive care, though on-scene time is a useful process marker - some great data from London showing effect of running chest pains in on blues is to halve scene to hosp time.
Anton
In message <001501c31a6c$433bf9a0$e177fea9@mydell> Adrian Fogarty <[log in to unmask]> writes:
> I was wondering if any of you - particularly the prehospital guys - know of
> any guidelines relating to time spent on scene prior to hospital arrival? I
> know there are targets relating to ambulance deployment, but are there any
> targets or guidelines stipulating how long a crew should reasonably spend
> with any particular type of case (I'm particularly thinking of a case of
> chest pain here) or is this left entirely to the discretion of the crew,
> depending on patient and local scene variability etc? I don't believe such
> guidelines exist, but I would welcome any advice.
>
> Thanks in anticipation...
>
> Adrian Fogarty
> A&E Consultant
> Royal Free Hospital
> London
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