----- Original Message -----
From: "Adrian Fogarty" <[log in to unmask]>
To: "Martyn Hodson" <[log in to unmask]>
Sent: Wednesday, September 24, 2003 8:30 AM
Subject: ECGs at the scene for thrombolysis
> I agree with Rowley; I still foresee many problems. For example, our SHOs
> have had several years' training on normal and abnormal ECGs (plus
variants)
> before being let loose on MI treatment - and they still need help with
most
> of their MI patients!
have they ? can we objectively measure this - ofr is just they have been
exposuedduring medicla education and had some questions in some of their
assessments on the topic?
> Paramedics have little or no experience of 12-lead ECG
> analysis, as far as I'm aware, although it could be argued that future
> training might include this.
and logically in the current clinical governance driven systems we are
seeing the trainign will be there before the schemes go live
> But when a department of our size only
> thrombolyses a couple of MIs per week, it's going to take a long time to
> build up experience and confidence among our local paramedic population.
hence the approaches certain services have taken in targetting their
training and then changing their systems to ensure someone with the
training is dispatched
>
> But performing ECGs at scene for MI patients means performing ECGs at
scene
> for all chest pains. There would then be further delays for non-MI
patients
> receiving opioid analgesia etc,
most services already give opioid analgesia ( after all nubain for all it's
faults is an opioid) and morphine sulphate is on the paramedic drug list now
( although few services have implmented it AIUI)
>unless paramedics are going to take this on
> too. Basically this needs to be carefully thought through. At the end of
the
> day these are very expensive drugs with very serious side-effects; I just
> don't see paramedics in my patch taking on this level of responsibility,
at
> least not when judging by the levels of decision making that they're
> currently required to undertake.
i suppose the same arguements were trotted out when acute chest pain
specialist nurses were first proposed ?
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