Why 12 lead in the field???
Appropriate transport disposition
Serial 12 leads, (multiple pictures of the heart)
Produces an accurate diagnosis (picture) of the heart at the time of symptoms prior to Rx Nitrates and MS.
Shortens door to needle time (tPA, nTA, SK and UR)
Shortens door to Cath Lab (P.T.C.A. Percutaneous Transluminal Coronary Angioplasty)
Shortens time to CABG (Coranary Artery Bipass Graft)
Disproves A.M.I. "Diagnosis of a non infarction"
If Thrombolytic therapy occurs in less than one hour there is as much of a decrease of appoximately 47% in mortality and decreases morbidity and improves ventricular function. This therapy has it's greatest impact, effect and benefit if it is administered in less than one hour from the door. The reperfusion strategies. Whether T.P.A. (Total Plasmagin Activator), SK (StreptoKinase), and or P.T.C.A. (Percutaneous Transluminal Coronary Angioplasty) is used, time is the number one factor. Nitrates alone can decrease mortality as much as 35%. Morphine Sulphate alone can decrease mortality as much as 21% and in conjunction with Aspirin, a reduction as much as 42%. Aspirin helps to prevent re-occlusion. Beta Blockers also decrease cardiac demand, the infarct and the malignant arrhythmias.
Of course considering the Continuum of the Evolution of the A.M.I.:"TIME IS THE MOST IMPORTANT FACTOR!!!"
Would it be safe to say that a primary 12 Lead E.C.G. is helpful to the E.D. physician and provides the first in a series of studies for the E.D. and the Cardiologist and decreases the first two time intervals considerably. OF COURSE IT IS!!!!!
En-route to the hospital or while the patient is being "packaged," a 12 Lead study can be accomplished in conjunction with O2 and Pharmacology vasodilator treatment with Nitrates and Morphine.
Is there a TIME DELAY ???
NO... Recent studies in San Diego County and across the country have proven that the average delay was less than a few minutes...
If we can minimize the time from THE ONSET OF SYMPTOMS to the DEFINITIVE CARE and DETECTION while at scene and in the ambulance rapidly transporting to the Emergency Department so the Physician at the DOOR can make an informed DECISION on his DATA and our SERIAL E.C.G. the DRUG and the DEFINITIVE THERAPY can begin sooner.
Obviously we as health care professionals can even educate our patients to recognize the symptoms and access the E.M.S. System EARLIER to further decrease the Time Continuum!!!
By, Mitch Mendler E.M.T. paramedic, City of San Diego Paramedic Services.
Heart and Stroke Facts: 1994 Statistical Supplement. American Heart Association 1994.
Rouan G.W. et al. Am J Cardiol 1994
Th. Cook EF. Weisburg M. et. al. Arch Intern Med 1985
The Department of Emergency Medicine and Office of Continuing Education, University of Massachusetts Medical School
The Cardiac Vasular System
Acute Ischemic Coronary Syndromes
The San Diego Fire Fighters & Paramedics