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In message <[log in to unmask]>, Michael Bjarkoy <[log in to unmask]> writes >The best >place for a 12 lead is in the back of the ambulance en route to hospital. Mike, please clarify: can you do RELIABLE 12-leads on the wider response range (0.05-150Hz) ON THE MOVE in the back of your bus? If so, good (you can radio us a 5-minute warning to get the retched clot-buster dissolved and in the drip-counter before you arrive). (referring to potential re-perfusion effects etc. in transit while lysis running).... > Thrombolysis wshould be administered prior to >transportation. Strep runs over an hour. My understanding is that this hour is the peak time for incidence of potentialy life-threatening adverse effects, during which time moving the patient (always a dangerous time) should be avoided. Are you suggesting staying at the patient's home / Waitrose / golf course etc. for the hour it takes the strep to drip in? YOU may want to run a mini-CCU at someone's bedside for an hour, and YOU may be very capable of dealing with the complications should they occur. I suspect many of your colleagues, not to mention A&E and CCU staff would not see this as progeress. Lets not get blinkered in to thinking that rapid pain to needle times are the only thing that is important in acute MI care. These patients belong in hospital a.s.a.p. and lysed equally quickly. With the advent of the single bolus effective lysis injection, or possibly rapid front-loading of lysis regimes, starting lysis pre- hospital may be advantageous even in this region, but strep doesn't lend itself to pre-hospital administration. >AHA recommends frequency response at 0.05 - 150Hrz. Good points about possible reasons for discrepancy. I'm still a little doubtful about the value of 12leads (espec ST changes) taken on the move. Perhaps your kit has more advanced movement artefact analysis than ours, but if one of our punters so much as sniffs during a 12-lead, it goes doolally. It will be interesting to see how our new Hewlett Packard 5-lead monitors (which you can do interpolated 12-leads from) compae with the HP stand-alone 12-lead machines and your pre-hospital 12-leads. Dr G Ray Staff Grade A&E Sussex Reply to [log in to unmask] %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%