 |
 |
I wish we could get away from this assessment at the door and listen to the description of the way the patient was when first presenting for care. I have been fighting this battle for at least 20 years! Why can the ambulance services not use Manchester Triage (Type 1 or 2) and simply pass that information to the A&E team too? > -----Original Message----- > From: Accident and Emergency Academic List > [mailto:[log in to unmask]]On Behalf Of Anton van Dellen > Sent: 20 April 2002 14:59 > To: [log in to unmask] > Subject: Re: Call to Door times > > > 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 >