12 Lead

[mongofire_99]

What are your thoughts on field use of the 12 lead.

I'll start with mine.

In a suburban area with close hospitals, it seems like a waste of time.

In extreme rural areas with long transport distances it may have some usefulness.

[Trauma_Dog]

It may seem like there are a waste of time if the hospitals you transport to are not using them. It is just as important to get a baseline 12-lead as it is to get a baseline set of v/s. I don't know how agressive your service, but our 12-leads are required before any Tx is performed, taking in consideration that the pt is not critical. We are part of the Timi 19 trials which is to say we are going to give TPA in the field and you can't do that w/o a good 12-lead.

Can most of your medic read them or do they give them to the doc. It really makes it interesting when you get good at reading them, almost makes it fun to see what you are going to get next and it very simple once you get the hang of it. Anyway just my opinion..that and a quarter will get you a cup of coffee.

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Kent Simon
Paramedic Incharge
MCHD EMS,
Montgomery Co.,TX

[benson911]

I thought the same thing - short transports don't need 12 lead. I was wrong. Not only can you do a twelve lead very quickly, any changes in the 12 lead you got compared to the 12 lead in the ER can help diagnose and treat the patient. It's not hard, it can be done quickly and it may help a patient. That's all I need to hear - try it you may like it.

[FIREMEDIC BILL]

Twelve lead EKG is advantageous in the pre hospital setting only if the results indicate a course of action for you to take or treat. For example, acute MI pt is 45 mint away from ER and you have TPA. So it seems yes 12 lead rural area and probably no if you are close to the hospital. It has been that most of my experience with 12 lead pre hospital does not change my treatment and moreover did not change receiving ER treatment. Thus, 99% of the time the ER is going to do their own 12 lead before the ER MD treats a pt we transport to them.

However, if no delay in transport or treatment(o2,ntg,asa,etc.), then why not? Yes do a 12 lead.

Be safe.

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FIREMEDIC BILL JENNINGS
GWINNETT FIRE/GRAYSON GA.
STATION 8-B SHIFT
ENGINE AND MED 8

[desoto]

I love it when someone posts a 12-lead topic on here. I work in a district that has a hospital right in the middle of it. My transport times are often less than 5 minutes and never more than 10-12. I do a 12-lead on every patient that I plan on giving nitro to. Why? Simple, because it's good patient care. I have found in my limited experience that medics resist running a 12-lead for 3 reasons;
1. They don't know how to run or read them.
While I understand that 12-lead is not something commonly taught in most EMT-P courses, it is a tool that provides information which can be invaluable to the medic on the street. It takes no skill to obtain, and even analysis is computer assisted (L.P. 11's and 12's). Our ignorance is not our patients' bliss.
2. They don't have the time.
Trauma patients don't need them, a pt. in arrest doesn't need them, and I'll always be more concerned about a critical airway than I will a 12-lead. They only take 2 minutes, 'nuff said.
3. It doesn't change the way you treat the patient. ( "Treat the patient, not the monitor ", is the mantra )
I don't have the time to start ranting about this excuse. It absolutely can and does change patient treatment at times. Granted, sometimes there is nothing significant on them that would lead to a change in the course of treatment, but how will you know unless it is run. Just because alot of the B/P's we take are 120/80 doesn't mean we stop taking them. Like Kent mentioned earlier, they are a baseline. Even if you're treatment is not affected, a change later in the E.C.G. can show a trend. If a 12-lead is run in the field and put with the patient's records, somewhere down the line in that patient's definative care, a cardiologist will be able to look at that 12-lead and see what changes if any that patient had at the time closest to the onset of symptoms. We treat these patients emergently while being mindful of what they will need longer term.
EMS has come a long way in the last 20 years, technology like the pre-hospital 12-lead will help us go further the next 20 if we can use it effectively.
Keep up the good work, and stay safe!

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Todd Gritter
Firefighter/Paramedic
Engine/Medic-10
Columbus Division of Fire
Columbus, Ohio

[Trauma_Dog]

One more thing that I overlooked. 12-leads are rapidly becomming the "standard of care" in ems not only for chest pain, but for CVA,pulmonary edema ect. Some of the classic signs of cardiac ischemia and injury cannot be seen in just 3-leads ex posterior wall, septal and anterior wall infarts.

That extra knowlede can be a use full tool when you have a pt where there family has called, but they do not want to go to the hospital. You pt can make more informed choices about their care.

Armed will an extra tool you better equiped to render the best pt care possible. Some required reading that I harp on all the time is chapter 9 and 10 in the current alcs textbook. It has some very eye opening insights on the Tx of AMI,CVA and HTN.

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Kent Simon
Paramedic Incharge
MCHD EMS,
Montgomery Co.,TX

[emt_chick]

Our squad recently started using 12-lead EKG's. We felt that is was necessary to use a 12-lead because we are so far from a hospital. Our area is a extreamly rural area. With 12-lead's, we have a chance to see more accuratly what is going on with the pt's heart.

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Sarah

[jfdr31]

I am in total agreement that 12 leads are a standard of care as referenced in the 1998 National Standard Paramedic Curriculum.
But lets put something personal into it.
A gentleman that lives in our territory has been battling with symptomatic heart palpitations for six months. Three 911 calls, two self transports, one holter monitor, and numerous md visits have proven fruitless as nothing is found.
One day while travelling down the road our station is on he has an episode, so he stops for us to check him. Low and behold we have a 12 lead, and for the first time in six months we have provided him and his doctor written proof of his PSVT. (which we cured with adenosine), and now he is on the appropriate oral med to control it.
'nuff said
Lt. Ken Devin RN/EMT-P/FF
Rescue 31 JFRD

[Boothby]

If you do a 12 lead right off the bat in the house, you will find that by the time you finsh all your other treatments and transport that the actual elapsed time is much longer than the 5 minutes it takes to get to the hospital. Don't let close hospitals deter you from using a 12 lead.

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Larry Boothby
Firefighter/Paramedic
Truck 3 A-shift
Local 1784
Memphis.

[Medic 16]

I have the fortunate opportunity to do 12leads in both rural and suburban settings. Through my own experience I have found 2 things.

1. If we are in an area with cell phone coverage we are required to transmit the 12lead to the command facility which may or may not be the receiving facility. I'm not sure if it is due to the MD's feeling that we as prehospital providers are not capable of accurately reading a 12lead or if they need a "hard copy" for the cardiology department so they will get their butts moving and have the cath lab available. This scenario is more true for the suburban setting and the actual door to drug time in an acute MI has not really changed due to them doing their own 12lead upon arrival but, it does allow them to compare the two.

2. In the rural setting where we have smaller hospitals some with no cariology department or cath lab and the inability to transmit the 12 lead. I've found that the door to drug time has actually been decreased to as much as 20 minutes. This is due to these smaller hospitals relying more on the prehospital providers ability to read the 12lead and beleiving our interpretations. Most of the time a repeat 12lead is completed but in most cases they are slaping their electrodes on before we move the patient to the ER bed or they will use the electrodes we used if left on the pateint.

In both instances the treatments (O2, ASA, NTG, IV, MsO4 etc.) are the same and I guess the only true answer to this is what is most appropriate for the patient. If you can see the ER from the scene or have less than 2-3 minute transport time then maybe the best thing to do is get them to the ER and start treatment while enroute. I agree with the other that it does not take very long to complete a 12lead but, I would change it to say that your first couple will seem to take to long, as always pratice, practice, practice.