Go watch Episode 2 of Code STEMI – Understanding STEMI from the ground up.
Tom Bouthillet of EMS 12 Lead talks with Dr. Christopher Granger, Mayme Lou Rettig and Dr. Jamie Jollis from Duke University Medical Center. They discuss Reperfusion of Acute Myocardial Infarction in Carolina Emergency Departments (RACE).
It is nice to see that the doctors are getting what is important.
The dichotomy between STEMI and trauma triage criteria could probably keep a team of psychiatrists busy for decades.
We want EMS to call the trauma alerts and we want EMS to call a lot of them, because maintaining competence in medicine is about the number of cases you see. Less than 5% accuracy is considered acceptable, since it is a numbers game and sometimes the blind squirrel actually looks like he can see. We grant a magical exception from medical competence in EMS, where we try to dilute paramedic experience to homeopathic levels by making almost every responder a paramedic (and usually those medics are cross-trained as something else, because that almost makes sense).
Since we discourage medical competence, we have to be creative in the excuses we use. Every system is unique, so we can’t claim that a system is screwing up – they are just meeting the needs of their patients in a way that works politically, but not medically, and we have to stop getting hung up on the medical part of EMS.
We reverse the criteria for calling STEMI alerts, but revert to magic as far as activation of the STEMI alert is concerned. We can’t trust medics, because even 5% over-triage is unacceptable. Interventional cardiologists are much more important than trauma surgeons.
Rather than have the medic focus on patient care and have his partner notify the hospital that they have a STEMI, there is still this need to distract the medic from paying attention to the patient so that the medic can focus on what is important – the magic phone call.
Here is a group of people not obsessed with the sleep of the STEMI team, but is interested in what is best for the patient.
What is best for the patient is reducing delays.
We need to make sure that paramedics know what they are doing.
We need to make sure that paramedics are getting appropriate feedback on their 12 lead interpretation and their patient care.
Imagine if EMS were about excellent patient care, rather than about dumbing it down to the comfort level of the most anxious and misinformed absentee medical director.
How much of a difference could we make in survival?
Go watch Episode 2 of Code STEMI – Understanding STEMI from the ground up.
Apparently, none of the pdfs work. Disregard the links below.
For more information on RACE view the presentations below. All presentations have been converted to PDF Format. The PDF Download will begin automaticall when you click a link below
Ideal World Case Study, by Jenny Underwood, RN, BSN RACE Coordinator for Durham/Greensboro/Chapel Hill
ACS Update, by Christopher Granger, MD
Lytic Hospitals; Meeting the Mark, by Mary Printz, Eastern NC RACE Coordinator
RACE for Reperfusion, NON PCI Center Focus
Presbyterian Hospital Matthews & Presbyterian Hospital HuntersvilleNorth Carolina Emergency Medical Services, by Greg Mears, MD, NC EMS Medical Director
Winston Salem Regional Report EMS ECG Transmission
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