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Adrian, Adrian Fogarty wrote: > > ----- Original Message ----- > From: Anton van Dellen > > > ST segment elevation, in the absence of the "typical" constellation of > > symptoms suggesting acute coronary syndrome (though patients often > > complain of non-specific numbness, general autonomic symptoms, etc.). > > Just to reiterate, these patients are not being considered for > > pre-hospital thrombolysis. > > So why do 12 lead ECGs on them? Because they get "labelled" as CCF exacerbations/unwell diabetics, get some oxygen, GTN and frusemide (in the case of CCF) and settle before arrival at hospital, where they are, quite rightly, triaged to not go into resuscitation on the basis of their physiological parameters and provisional diagnosis. Yet the evidence from Leeds is that they are a high risk group with regard to outcomes (Dorsch et al, Poor prognosis of patients presenting with symptomatic myocardial infarction but without chest pain, Heart 2001 Nov;86(5):494-8: "This may result in part from a failure to use beneficial treatment strategies"). > > > Paramedics do not at present interpret 12 leads > > the ECGs are transmitted and medical direction given to crew (thrombolyse > or not, blues or not) > > more of a US style of medical direction than was previously traditional in > the UK. > > Maybe this works in rural areas, but sounds like a right palaver in my > patch. Here most transport times to hospital are under 10 minutes. Even > doing a 12 lead would be meddlesome and simply delay transport! > Yes, where there is only a crew of 2, they would probably be delayed. With the dispatch of a community paramedic officer (CPO) to assist the crew, there is an extra pair of hands on scene, and the actual transmission of the ECG, which is the time-consuming bit, ensues by the CPO. We track on-scene times very closely indeed and have found no evidence that there is an increase in on-scene times for chest pain patients since the advent of CPOs and pre-hospital 12 lead acquisition. You are, of course, quite right - I am very conscious that we have evolved this system within the parameters of a predominantly rural service and cannot speak for metropolitan colleagues. However, I was under the impression that it was the policy of the LAS to roll out a programme of pre-hospital 12 lead ECG acquisition, but am open to correction. Anton Staffs