Advanced Life Support paramedics

The primary function of Advanced Life Support paramedics is to provide prehospital medical emergency care. Advanced Life Support, on the other hand, provides life-sustaining skills by improving circulation and maintaining an open airway and appropriate ventilation. The use of 12-lead ECGs is becoming more common due to a variety of conditions that need their use. The empirical data supporting the use of the 12-lead ECG in practice is as follows:

More than 90% of the EMS systems servicing the 200 largest cities in the United States have already purchased 12 lead ECG equipment. Additionally, EMS providers can quickly acquire diagnostic-quality prehospital ECG’s thus increasing their on-scene time interval by 5 to 6 minutes (Wade, 2007). It is important to note that although the access to the equipment is there, more needs to be done regarding its use to increase efficiency and minimize mistakes. Movement of the equipment, lead misplacement, and poor skin contact are just some of the issues paramedics need further training on to reduce misinterpretation due to poor-quality tracing (Daudelin et al., 2010). Once this has been improved on, electrocardiography can thus provide early diagnosis and reduce delays

Accuracy and Feasibility

The accuracy and viability of 12 lead ECG performances have been documented in numerous studies. Also, the ability of paramedics to accurately perform checklists safely and therapeutically has been studied and documented. A good example is a five-year study in Canada which showed that paramedics could precisely identify patients with the greatest likelihood of benefiting from early, aggressive thrombolytic therapy. With this in mind and the presence of ECG, the response time of aiding such a patient is significantly heightened. Furthermore, a study in the UK to determine the need for training on ECG interpretation was negated since a multitude evidence showed that well-trained paramedics have the same knowledge on the 12 lead electrocardiography same as qualified cardiologists (Johnston, 2006). All this points to the successful implementation of 12 lead ECG for Advanced Life Support (ALS) paramedics thus supporting the change in practice.

Incorporation into Existing Systems of Care

Many hospitals have already started the implementation of prehospital ECG programs that are in varying stages of development. A good example of regions already implementing the concept through available programs includes Boston, North Carolina, Ottawa and Los Angeles. In these areas which are pioneers of the model, it involves training of paramedics, the interpretation and categorization of prehospital ECG’s as definite STEMI, possible STEMI, or non-diagnostic (Ting et al., 2008). The reason behind this form of classification is to offer physicians and hospital institutions more information regarding the patient’s condition and preparing intervention methods before arriving at the hospital.

Depending on the geographical size, some places such as Boston which is relatively small has only included local paramedics in the program while leaving out private EMS providers. However, other geographically big areas such as Los Angeles have accommodated both stakeholders (Bouthillet, 2012). Unlike other regions, L.A has a huge number of paramedics which makes training and interpretation of ECG impossible. Hence, the need for computer algorithm analysis for reliable patient transport to the closest hospital. Subsequently, the physician decides whether to activate the catheterization laboratory from the computer algorithm interpretation while the patient is on his way to the hospital.

From the above empirical facts it is clear that implementation of 12 lead ECD is on the right path towards better patient management by paramedics. Although more needs to be done it is hard to ignore the significant made thus far by implementing the equipment in ALS paramedics.

References

Bouthillet, T. (2012). Who should receive a prehospital 12-lead ECG?. EMS1. Retrieved 6 March 2017, from https://www.ems1.com/cardiac-care/articles/1276633-Who-should-receive-a-prehospital-12-lead-ECG/

Daudelin, D., Sayah, A., Kwong, M., Restuccia, M., Porcaro, W., & Ruthazer, R. et al. (2010). Improving Use of Prehospital 12-Lead ECG for Early Identification and Treatment of Acute Coronary Syndrome and ST-Elevation Myocardial Infarction. Circulation: Cardiovascular Quality And Outcomes, 3(3), 316-323. http://dx.doi.org/10.1161/circoutcomes.109.895045

Johnston, S. (2006). Paramedics and pre-hospital management of acute myocardial infarction: diagnosis and reperfusion. Emergency Medicine Journal, 23(5), 331-334. http://dx.doi.org/10.1136/emj.2005.028118

Ting, H., Krumholz, H., Bradley, E., Cone, D., Curtis, J., & Drew, B. et al. (2008). Implementation and Integration of Prehospital ECGs Into Systems of Care for Acute Coronary Syndrome: A Scientific Statement From the American Heart Association Interdisciplinary Council on Quality of Care and Outcomes Research, Emergency Cardiovascular Care Committee, Council on Cardiovascular Nursing, and Council on Clinical Cardiology. Circulation, 118(10), 1066-1079. http://dx.doi.org/10.1161/circulationaha.108.190402

Wade, B. (2007). Distant Early ECG Warning | EMSWorld.com. EMSWorld.com. Retrieved 6 March 2017, from http://www.emsworld.com/article/10322040/distant-early-ecg-warning