900,000 Americans have an MI every year! 30% mortality in 1st year. Pre-admission mortality of 15-20%.

EKG is the most time-honored test for evaluation of the cardiac patient. Initial EKG diagnostic of MI in 25-50% of proven infarctions. Used as a tool... Goals of Prehospital Management of Chest Pain Identify and treat immediate life threats. Formulate a differential. Identify potential acute MI. initiate treatment assign acuity triage appropriately Goals of Prehospital Treatment of Myocardial Infarction Decrease myocardial oxygen consumption. Limit infarct size and incidence of vfib. O2, NTG, analgesia, ASA, b-blockers Decrease time to definitive care and restoration of flow in occluded vessel. Transmission of 12 lead EKG Appropriate triage Prehospital EKG Programs 87 Grim recognized 12 leads can be easily transmitted from a moving ambulance using cellular telephones. This allows diagnosis before hospital arrival, improves prehospital triage of patients and may facilitate prehospital therapy Does EKG Acquisition Prolong Scene Time? Many studies done in different environments. Benefits of decreased door to treatment intervals outweigh any small increase in scene time. Impact on scene time is protocol dependent. Spinal cord immobilization in trauma analogy... Importance of Early Revascularization MITI data (Weaver, JAMA 1993;270:1211) mortality of 1.2% (Rx <70min) vs. 8.7% (Rx in 70-180min) decreased risk of sudden death The sooner the better! Time is muscle... The Impact of Transmitted 12-lead EKGs on Time to Treatment Karagounis, et al (Am J Cardiol 1990;66(10):786) With Field EKG 48 min to Rx

Without Field EKG 103 min to Rx Kereiakes, et al (Am Heart J 1992;123(4Pt1):835) With Field EKG 30 min to Rx Without Field EKG 50 min to Rx The Impact of Transmitted 12-lead EKGs on Time to Treatment Foster, et al (Am J Emerg Med 1994;12(1):25) With Field EKG 22 min to Rx Without Field EKG 51 min to Rx Canto, et al (J Am Coll Cariol 1997;29(3):498) With Field EKG 30 min to lysis 92 min to PTCA Without Field EKG 40 min to lysis 115 min to PTCA Current Reality 12 Lead EKGs can be appropriately applied and transmitted by EMS. Field transmission has been established as an important tool in decreasing door to treatment times. Most commonly used as an early notification device. Other Impacts Helps EMS providers to choose best destination based upon resource availability. Mode of transportation decisions. Urban and Rural impacts differ. We currently use 12 lead in some programs in my area. I find that it is necessary in order to get things truly ready in the hospital prior to patient arrival. If a medic calls in a patient with an MI...I see the patient then call the cath team...they won't come in till I've seen the EKG. If the EKG is faxed or sent to me some way...I've seen it and can call in the cath team, sometimes having them ready before the patient even arrives in the ED!!! That's an impact! Good luck! Deb Funk MD EMT-P

-----Original Message----From: Ed Michelson, MD <emichelson@nwu.edu> To: ems-l@listserv.ACNS.NWU.EDU <ems-l@listserv.ACNS.NWU.EDU> Date: Monday, August 02, 1999 10:29 PM Subject: Pre-hospital EKG's:

>Michael > >We do not use pre-hospital 12 lead ECG's in Chicago. I reccomend a >lit search on not only medline, but also CNAHLS on the topic. I also >have added you to EMS-L list and am forwarding your request to the >list so individuals can relate their current experiences with pre>hospital 12 leads. > >Ed Michelson, MD >Chair, NAEMSP Computers and Technology Committee >'Owner' EMS-L > > >Dr. Michelson, > > I am a full-time firefighter/EMT-I in Hampton, NH. I am currently in >paramedic school, hoping to tes this fall. As part of this course I must do >a research project. I am looking into the implementation of pre-hospital >12-lead EKGs. Benefits (to the patient), drawbacks, costs and training >requirements are among the topics to be covered. If you can direct me to >any sources of this information (especially any studies of patient outcomes) >I'd be most grateful. > >Thanks for your help. >Michael McMahon >FF/EMT-I Hampton Fire Department ><!DOCTYPE HTML PUBLIC "-//W3C//DTD W3 HTML//EN"> > ><HEAD> > ><META content=text/html;charset=iso-8859-1 http-equiv=Content-Type> ><META content='"MSHTML 4.72.3110.7"' name=GENERATOR> ></HEAD> > ><DIV>Dr. Michelson,</DIV> ><DIV>&nbsp;&nbsp;&nbsp; </DIV> ><DIV>&nbsp;&nbsp;&nbsp; I am a full-time

>firefighter/EMT-I in Hampton, NH.&nbsp; I am currently in paramedic school, >hoping to tes this fall.&nbsp; As part of this course I must do a research >project.&nbsp; I am looking into the implementation of pre-hospital 12-lead >EKGs.&nbsp; Benefits (to the patient), drawbacks, costs and training >requirements are among the topics to be covered.&nbsp; If you can direct me to >any sources of this information (especially any studies of patient outcomes) >I'd >be most grateful.</DIV> ><DIV>&nbsp;</DIV> ><DIV>Thanks for your help.</DIV> ><DIV>Michael McMahon</DIV> ><DIV>FF/EMT-I Hampton Fire >Department</DIV> >Ed Michelson, MD >Northwestern University Medical School >Chicago, IL > >

----------------------- Headers -------------------------------Return-Path: <owner-EMS-L@listserv.ACNS.NWU.EDU> Received: from aol.com (rly-yb05.mail.aol.com [172.18.146.5]) by air-yb02.mail.aol.com (v60.18) with ESMTP; Tue, 03 Aug 1999 08:48:29 2000 Received: from listserv.acns.nwu.edu (iris.itcs.nwu.edu [129.105.213.30]) by rly-yb05.mx.aol.com (v60.18) with ESMTP; Tue, 03 Aug 1999 08:48:04 -0400 Received: (from mailnull@localhost) by listserv.acns.nwu.edu (8.8.7/8.8.7) id HAA17684; Tue, 3 Aug 1999 07:47:57 -0500 (CDT) Received: from localhost(127.0.0.1) by iris.itcs.nwu.edu via smap (V2.0) id xma017651; Tue, 3 Aug 99 07:47:53 -0500 Received: (from mailnull@localhost) by listserv.acns.nwu.edu (8.8.7/8.8.7) id WAA05122 for <EMS-L@listserv.ACNS.NWU.EDU>; Mon, 2 Aug 1999 22:49:30 -0500 (CDT) Received: from kermit.empireone.net(207.111.39.2) by iris.itcs.nwu.edu via smap (V2.0) id xma005116; Mon, 2 Aug 99 22:49:05 -0500 Received: from funk (shiva1-204-192-122-24.empireone.net [204.192.122.24]) by kermit.empireone.net (8.8.7/8.8.7) with SMTP id XAA28491 for <EMS-L@listserv.ACNS.NWU.EDU>; Mon, 2 Aug 1999 23:49:01 -0400 (EDT) Message-Id: <01bedd64$6122eee0$187ac0cc@funk> Date: Mon, 2 Aug 1999 23:58:00 -0400 Reply-To: EMS-L@listserv.ACNS.NWU.EDU Sender: owner-EMS-L@listserv.ACNS.NWU.EDU From: "Deb Funk" <dfunk@empireone.net> To: <EMS-L@listserv.ACNS.NWU.EDU> Subject: Re: Pre-hospital EKG's: MIME-Version: 1.0 Content-Type: text/plain;