The Evidence for EMS

     In recent years, there has been much discussion in the EMS community about evidence-based medicine and how to prove that prehospital medicine makes a difference in patient outcomes.

     A recent article in the New England Journal of Medicine provides "evidence" for the important role EMS providers play when treating patients experiencing myocardial infarctions with ST-segment elevation. The article details how researchers sought to identify ways in which hospitals are trying to improve door-to-balloon times for STEMI patients. Current guidelines recommend that the interval between arrival at the hospital and intracoronary balloon inflation should be 90 minutes or less. The researchers quantified average time savings at 365 hospitals that had implemented changes to reduce that interval and came up with six recommendations. Out of those six, EMS acquisition, interpretation and transmission of 12-lead ECGs was found to save more time (15.4 minutes) than any other intervention except requiring cath lab personnel to respond to the hospital within 20 minutes of being paged.

     In this issue, EMS Magazine's medical editorial consultant, David Jaslow, MD, MPH, EMT-P, discusses the potential impact of this research and how EMS systems can develop out-of-hospital STEMI alert capabilities (see Out-of-Hospital STEMI Alert, p. 50). Jaslow argues that EMS providers calling "trauma alerts" are now considered routine in most metropolitan areas, so why not do the same for cardiac care?

     The folks at Tampa Fire-Rescue (TFR) agree and have recently implemented a 12-lead acquisition and transmission program (see Distant Early ECG Warning, p. 43). Over a period of six months, 275 TFR field paramedics were taught how to properly acquire and interpret 12-leads. The successful save of a 46-year-old man is detailed in the article. As advances in emergency medicine continue, how will your system embrace changes in practice? E-mail your thoughts and ideas to nancy.perry@cygnusb2b.com.