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
>