EMT Bs and a 12 lead

[Medic744]

I searched the threads and didnt find what I was looking for so here it goes. We just got back to the station from a CP that we had to mutual aid over to another city for. Unfortunately they have 5 trucks (all out on calls) except for one that was a BLS truck. It took us 14 min to get there and on arrival the EMT Bs had already gotten vitals and went ahead and hooked the patient up to their 3 lead. My question to my partner when it was all said and done is how he felt about having the BLS be able to run a 12 lead prior to our arrival so that we at least have a baseline EKG to compare with. We both agreed that it would not be a bad thing. Even if they can't read it, it would be nice to have to compare to mine. I realize there are a few hurdles in that dept, but like with my patient today she literally had at least one of everything we have ever learned to look for at least once during transport (ST depression, PVCs, PACs, Sinus Tach, Sinus Brady). And it would just have been nice to get there and have one to compare to mine and the one at the hospital. So I guess what I want to know is how others feel about allowing EMT Bs to at least run the EKG for us before we arrive on scene.

 

[firecoins]

I don't see the point. BLS rigs here do not carry a monitor and spending thousands of more dollars to equipment seems extraneous.

 

[gicts]

If I am not mistaken some BLS units in our area do have Life Pacs and send rhythms to hospitals before their arrival. That and setting up for medics are the only things I can imagine them being used for.

 

[firemoose0827]

If I am not mistaken some BLS units in our area do have Life Pacs and send rhythms to hospitals before their arrival. That and setting up for medics are the only things I can imagine them being used for.

This, and another reason. Im my squad we are volunteer, but we are ALS certified and only have 3-4 ALS providers. If they dont show, we ask for the County Medics to respond. My squad trains all of the members in the set up of certain things like ECG, and IV's so we can assist the medics. This helps. So when we respond as a BLS crew with a county medic responding from 10 minutes out, we can be on scene and have the monitor attached and strip printed out for the medic. When they get there we grab a bag of fluid and spike it for the medic too, so when they get the IV the bag is ready to go. It helps. We are here to help. Whats wrong with Basics helping Medics? Good topic.

 

[akflightmedic]

This, and another reason. Im my squad we are volunteer, but we are ALS certified and only have 3-4 ALS providers. If they dont show, we ask for the County Medics to respond. My squad trains all of the members in the set up of certain things like ECG, and IV's so we can assist the medics. This helps. So when we respond as a BLS crew with a county medic responding from 10 minutes out, we can be on scene and have the monitor attached and strip printed out for the medic. When they get there we grab a bag of fluid and spike it for the medic too, so when they get the IV the bag is ready to go. It helps. We are here to help. Whats wrong with Basics helping Medics? Good topic.

Before I respond, and hopefully some of the other ALS providers will follow my lead...would you please take the time to explain how and what you teach the BLS providers i n order for them to do a 12 lead?

Please go into detail regarding everything you cover or give a very thorough outline with the important highlights noted.

 

[firemoose0827]

Before I respond, and hopefully some of the other ALS providers will follow my lead...would you please take the time to explain how and what you teach the BLS providers i n order for them to do a 12 lead?

Please go into detail regarding everything you cover or give a very thorough outline with the important highlights noted.

Sure...Ill try. First off, we dont do anything with the 12 leads, just 3 lead. But regardless of what I explain here there will be the ones that just tear it apart and be the usual monday morning quarterback, just like in every discussion that has something that someone is not sure of, or has never seen before.

Medics from both the squad and the County come to drill night. They take the monitor we have in both of our rigs. They show the Basics where the leads are placed (Isnt hard, a monkey can do it.) Than show how to turn on the monitor, and than how to print out a strip...Is that realy hard? They are not reading the rhythm, they are not making any diagnoses, just simply printing a strip to show the medics what the rhythms were when the BLS crew arrived. The medics here have no problems with that and I dont see why some here cant grasp that...The doctors know of it, the nurses know of it and they all agree and help whenever possible.

IV's. We take the drip set (the appropriate one) and go through the steps of spiking a bag of IV fluid, filling the chamber, and bleeding the line to prepare it for hooking it to the IV catheter. We than are instructed on arranging the various other supplies like blood tubes, tape strips, tegaderms, saline flushes, etc etc so the Medic has all they need at their finger tips when they need it. The county medics love doing calls with us because they know all of this will be done for them and they can worry about patient care.

We checked our SOP's and by-laws, we checked with our med control director, and we checked with the State EMS office about the legalities of this and it all checks out OK. The County EMS Coordinators, who are also ALS fly cars, are involved with the training of the basics, hell, they are the instructors who teach Basic EMT in our county to begin with, and they agree with it.

Dont know what the issue is. Hope this helps you. Stay Safe.

[RANT]An after thought here as I read through my post. I see where you might be potentially headed with this and I will intervene before it gets there...if I am correct in my guess that is.
We do not tunnel vision and forget the basic BLS skills we should be performing. We arrive on scene, do an assessment, render treatment as needed like O2 and bandaging and what not, get a full set of vitals and history, THAN...and only than do we hook up the monitor and print a strip for the arriving medics. Ninety percent of the time we are doing this with the medic present as he/she gets their assessment done and renders any other treatments anyway. So no...we do not forget what our BLS skills are and we do not forget them. We dont run in to the house with monitor in hand and run up to the patient and immediately slap the electrodes on and print a strip than sit there and wait...(something reminiscent of a Steve Berry Cartoon.) We do our jobs than we assist where we can. [END OF RANT/]

 

[daedalus]

What if the patient is in need of cardioversion, and an enterprising EMT recognizes the strip he just printed out. The monitor is there, but no medic. Should they for the good of the patient go ahead and zap him? Or do you tell the family of the dying patient you cannot use your own equipment until other personnel arrive?

 

[Shishkabob]

Or do you tell the family of the dying patient you cannot use your own equipment until other personnel arrive?

Yes. That's exactly what you do. Or just keep doing the primary assessment without even letting them know that it CAN be used for more.

Chances are a civilian won't know that you can cardiovert using the monitor, and the ones that DO realize, will most likely undertsand the differences in cert levels as well.

 

[MMiz]

What if the patient is in need of cardioversion, and an enterprising EMT recognizes the strip he just printed out. The monitor is there, but no medic. Should they for the good of the patient go ahead and zap him? Or do you tell the family of the dying patient you cannot use your own equipment until other personnel arrive?

Where I worked we had EMT-Paramedics that acted as first responders or "Echo" units. They would literally master the city/locations, and would arrive on scene to help an ALS crew. Each call got an ALS rig (Paramedic/Paramedic) and a Paramedic First Responder. They carried all of the ALS gear, but could only operate at the BLS level until the ALS unit arrived.

They would hook the patient up to the monitor, even run a 12 lead if necessary, but any treatment from the defib. was in AED mode until ALS arrived. They also had full airway equipment, but they would not insert an ET tube until the ALS unit arrived. They would prep for an IV, but again, not put one in until ALS arrived.

At the time our ALS arrive average time was just over three minutes, so it wasn't a big deal.

 

[Shishkabob]

What was the logic behind such a plan?


You're an ALS provider, with ALS gear, but can't do anything until you have more ALS personnel?

 

[Summit]

In CO, EKG is offered as a 2 credit hour (24-32 classroom hours) for Basics. 3 lead interpretation is the main emphasis as well as cardio A&P is covered, 1st line cardiac drugs, and how to hook up a 12 lead. Basics are allowed by the state to capture strips and transmit data. The state does not allow Basics to interpret 3 lead etc.

 

[MMiz]

What was the logic behind such a plan?


You're an ALS provider, with ALS gear, but can't do anything until you have more ALS personnel?

1. It guaranteed the city several Paramedic first responders in vehicles dedicated to the city. They would not get called way to other areas.
2. Now you had a crew of three working ALS calls instead of two

I worked for a private service, and like many private services, we served multiple cities. The idea was that one of our most highly trained Paramedics would arrive on scene first and initiate care, while a fully staffed ALS ambulance also arrived. Once the ALS crew arrived they would immediately "upgrade" to ALS and continue with ALS interventions. If the call was truly an emergency then you had two Paramedics working in the back of an ambulance instead of only one.

The hope was that the county would recognize our program and allow the single Paramedic to start ALS treatments alone, but that never happened.

 

[Shishkabob]

That's why I'm wondering their reasoning.


I totally get the fly-car idea. I don't get forcing a medic to act as strictly BLS because there isn't another medic there, when they obviously have the tools, training, and other items required to be ALS.

 

[emtjack02]

What if the patient is in need of cardioversion, and an enterprising EMT recognizes the strip he just printed out. The monitor is there, but no medic. Should they for the good of the patient go ahead and zap him? Or do you tell the family of the dying patient you cannot use your own equipment until other personnel arrive?

Are you referring to a coding pt or one that is conscious?

 

[akflightmedic]

Sure...Ill try. First off, we dont do anything with the 12 leads, just 3 lead. But regardless of what I explain here there will be the ones that just tear it apart and be the usual monday morning quarterback, just like in every discussion that has something that someone is not sure of, or has never seen before.

Medics from both the squad and the County come to drill night. They take the monitor we have in both of our rigs. They show the Basics where the leads are placed (Isnt hard, a monkey can do it.) Than show how to turn on the monitor, and than how to print out a strip...Is that realy hard? They are not reading the rhythm, they are not making any diagnoses, just simply printing a strip to show the medics what the rhythms were when the BLS crew arrived. The medics here have no problems with that and I dont see why some here cant grasp that...The doctors know of it, the nurses know of it and they all agree and help whenever possible.

IV's. We take the drip set (the appropriate one) and go through the steps of spiking a bag of IV fluid, filling the chamber, and bleeding the line to prepare it for hooking it to the IV catheter. We than are instructed on arranging the various other supplies like blood tubes, tape strips, tegaderms, saline flushes, etc etc so the Medic has all they need at their finger tips when they need it. The county medics love doing calls with us because they know all of this will be done for them and they can worry about patient care.

We checked our SOP's and by-laws, we checked with our med control director, and we checked with the State EMS office about the legalities of this and it all checks out OK. The County EMS Coordinators, who are also ALS fly cars, are involved with the training of the basics, hell, they are the instructors who teach Basic EMT in our county to begin with, and they agree with it.

Dont know what the issue is. Hope this helps you. Stay Safe.

[RANT]An after thought here as I read through my post. I see where you might be potentially headed with this and I will intervene before it gets there...if I am correct in my guess that is.
We do not tunnel vision and forget the basic BLS skills we should be performing. We arrive on scene, do an assessment, render treatment as needed like O2 and bandaging and what not, get a full set of vitals and history, THAN...and only than do we hook up the monitor and print a strip for the arriving medics. Ninety percent of the time we are doing this with the medic present as he/she gets their assessment done and renders any other treatments anyway. So no...we do not forget what our BLS skills are and we do not forget them. We dont run in to the house with monitor in hand and run up to the patient and immediately slap the electrodes on and print a strip than sit there and wait...(something reminiscent of a Steve Berry Cartoon.) We do our jobs than we assist where we can. [END OF RANT/]

Thanks for replying. Since it is limited to a 3 lead only, I have no further comment as I thought you were implying you perform 12 leads prior to medic arrival. I was going to get into placement, positioning of patient, etc, because there are a lot of medics that do not even know that stuff and do it incorrectly every time.

My only issue with the way you do it, is someone already mentioned it. The thought of having equipment on scene, knowledge of a problem, but no licensure or true education to fix the problem. It is like 2 basics arriving in an ambulance that says Advanced Life Support or MICU or whatever language your area uses...it is false representation.

I think it is potentially bad juju and there will be fallout somewhere, sometime, eventually.

 

[daedalus]

Are you referring to a coding pt or one that is conscious?

Ether or. Doesn't matter. My post was to demonstrate the stupidity of EMTs carrying around a machine that they cannot use, where there will be people pressuring them to use it.

 

[MMiz]

Ether or. Doesn't matter. My post was to demonstrate the stupidity of EMTs carrying around a machine that they cannot use, where there will be people pressuring them to use it.

I love working in an ALS truck. We don't have to mess around with switching cots and missing equipment. ALS hops in and we take off, and everything they need is where it should be.

 

[Medic744]

My main pondering on this was that I would like a 12 lead EKG as a baseline from a BLS crew when I get there. A large amount of services in our area allow Basics to admin ASA and NTG and if they are going to allow it (which is fine with me) then I would like to know what the inital EKG looks like before I start giving anything else. I used to be one of the Basics that had everything ready when the Paramedic arrived on scene including 12 leads. I was trained in lead placement for 2 diff Dr offices I worked for long before joining EMS. God Bless every Basic out there that gets my stuff ready in the back of the truck, I am greatly appreciative of it. We were all Basics once.

 

[chadwick]

I wouldn't do it

My old partner brought his mom in, hooked her up on the cardiac monitor, ran the 12 lead, and then while she was on it, she started complaining of chest discomfort and we called for a paramedic.

Because I was present at the station and read what the ECG printed out as a diagnosis before the paramedic got there, I was written up by a third EMT, investigated by the state board of emergency medical services, put on probation for a year, and forced to take 4 hours of continuing education in the roles and responsibilities of EMT-B.

I was watching him do it just the same as the guy that wrote me up and when she began having discomfort began asking her OPQRST and SAMPLE questions. They said I should have stopped him from touching the monitor without the paramedic present. The EMT-B curriculum in Kentucky teaches EMTs to hook up the monitor only if they are working on an ALS truck with a paramedic present.

I would not under any circumstances recommend to any EMT to use the cardiac monitor before the medic gets on scene. If someone at the station doesn't like you, like this old fart who wrote me up did, you could get in a heap of trouble.

 

[TransportJockey]

In NM I think expanding education to include monitor usage might not be a bad thing. As a basic here I can run 4-lead strips for facilities/medics, I just can't interpret.

All NM ambulances, as far as I know, are required to carry a monitor.