SEMAC Mandating 12 Lead

[MerlinMedic 5]

Recently I saw a notice that SEMAC would require all ALS agencies to have 12 lead capability by 7/1/10. Can anyone confirm this AND provide documentation? I searched the SEMAC web site & could not find this as a mandate. Please note: this is NOT a discusion on the merits of 12 leads, I well know their worth. Thanx

[WAS967 97]

I'm not sure about 12-leads, but a recent SEMAC advisory "strongly encourages" that any ambulance in service have the ability to defibrillate and administer epi via auto injector if they don't already have that ability via ALS equipment.

http://www.health.state.ny.us/nysdoh/ems/policy/10-01.htm

12-Lead units are admittedly expensive, despite their huge benefit, and some ambulance agencies upstate can barely afford defibrillators, much less 12-lead capability. So I sincerely doubt such a statewide mandate exists.

Interesting tidbit about the above advisory that I've been thinking about: They want the ability to defib patients of "any age group". Last I checked most AEDs were only approved for use on kids 1 year of age and older. What do they do for infants? (Or has that changed without me knowing?)

Update: Yup. They changed it. AAP has approved of AED use on infants (kinds under 1 year of age).

Edited March 16, 2010 by WAS967

[ny10570 745]

Its more than encouraged. Its required come May 1st.

[helicopper 1,050]

Its more than encouraged. Its required come May 1st.

Please cite the source of this requirement. Thanks.

[chris 18]

Recently I saw a notice that SEMAC would require all ALS agencies to have 12 lead capability by 7/1/10. Can anyone confirm this AND provide documentation? I searched the SEMAC web site & could not find this as a mandate. Please note: this is NOT a discusion on the merits of 12 leads, I well know their worth. Thanx

Could you tell me the difference between what the normal E.M.S. rig has now and the 12 lead, why will it be better? ( how many leads do you use now ) I know nothing about E.M.S. and can prove it..

[Guest alsfirefighter]

First..if they are requiring it...its about time. I've been doing them for nearly 10 years now on all chest pain patients and anyone with an abnormal heart rythms.

Chris:

What the difference is per agency depends on what monitor the unit carries. Most of what I've seen all agencies have switched to monitors that have 12 lead capability. With the LifePak 12 being from what I have seen the most popular in this area. With that said, basically things for the most part stay the same with the LP-12 having 4 connectors (limb leads) for the electrodes which allows you to get the most views with just those 4 connected. What 3 you want to view on the screen is up to the agency's policy or user preference, I most often keep my intial 3 as leads II, III and aVf which is just fancy for what "views" of the electrical activity of an area of the heart. With a 12 lead I have another adjunct which has 6 additional cables or "leads" which I then put on the patient in the same form as you would getting a 12 lead EKG at a doctors office or ER and that device connects to the same section the limb leads combine into 1 cable. A push of a button and my LP 12 goes through its 12 lead process and prints out the results. It also gives some recommendations for what it has read, but these should only be used as a guide to the provider as a good paramedic knows what to look for and how to read them. It doesn't take all that much more additional time if the medic is good at managing their scene time, assessment and care and gives a good initial view of what the underlying rhythm was prior to the admin of medications which can cause changes prior to arriving at the ED. 12 leads are the standard of care in most systems in the U.S. Well proactive ones anyway.

If this isn't clear enough, hook up with me next time we're teaching together and we'll discuss it more.

[chris 18]

Thanks for the info. You keep mentioning paramedic, is this only for medics ( als ) type fly cars and rigs?

[ny10570 745]

Yep. Its an ALS intervention.

Chris 192, here you go... http://www.nyhealth.gov/nysdoh/ems/policy/10-01.htm

[WAS967 97]

ny10570: Thats the advisory I saw. What confuses me about it however is in one spot it says that epi/defib is required, but in another place it says the advisory is "strongly encouraged". Why "strongly encouraged" I wonder. Make the damned things required and be done with it. Any ambulance that doesn't have at LEAST an AED on it is just playing with fire. Not having one IMHO is a liability.

I'd love to see 12-leads required on all ALS units but because of the expense, I don't see agencies up state being able to bear it in the immediate future.

EDIT: Now I get it....had to read it a few times for it to click. During the time in which the amendment is being pushed out, they are strongly suggesting you have AEDs and EpiPens. But come May 1st, 2010, it will be required. And yes, there are ambulances out there that don't go out on the road with a defib on it. Kinda hard to believe in this day and age.

Edited March 29, 2010 by WAS967

[helicopper 1,050]

Yep. Its an ALS intervention.

Chris 192, here you go... http://www.nyhealth.gov/nysdoh/ems/policy/10-01.htm

Thanks. That policy statement speaks to AED's and epinephrine but doesn't mention 12-lead EKG's at all.

I looked through all the policy statements and don't see it mentioned anywhere. Can anyone cite a policy statement or regulation for this requirement?

[ny10570 745]

I agree Chris. On a similar note allegedly AHA is going to suggest 12 leads be made available to BLS providers.

[Engfire 0]

Here in my region of Ohio 12-lead is the norm, but is not required (however all but 1 or 2 agencies has the ability), we also have the ability to transmit to the ER if we see something of significance. We also have a program called cardiac alert witch lets us make an alert that notifies the needed people (cath Lab) when we see something of significance. Just recently added is the transmission of 12-leads by EMTs (properly trained on lead placement) if approved by your dept and Medical Director.

[Goose 188]

Here in my region of Ohio 12-lead is the norm, but is not required (however all but 1 or 2 agencies has the ability), we also have the ability to transmit to the ER if we see something of significance. We also have a program called cardiac alert witch lets us make an alert that notifies the needed people (cath Lab) when we see something of significance. Just recently added is the transmission of 12-leads by EMTs (properly trained on lead placement) if approved by your dept and Medical Director.

There is a pilot program that is getting ready to take off here as far as transmitting 12 leads, i know some units do it in the city as well. Making a note is great, but every time i've been involved in said situation the ER has never bothered to get anything ready. It's not until you pass the 12 lead under the nose of the ER physician that he jumps out of his chair and franticly starts making phone calls...

[JJB531 652]

I agree Chris. On a similar note allegedly AHA is going to suggest 12 leads be made available to BLS providers.

I don't know if I can see a benefit to prehospital 12 lead EKG's in this area. I am generally a fan of proactive procedures, but in my experiences with prehospital 12 leads, the ER docs may take a glance at them but still perform their own 12 lead and base their treatment modalities off of their EKG.

A 12 lead is a great diagnostic tool, but I have never altered a course of treatment based on a 12 lead after a "routine" EKG. Has anyone changed their course of treatment based specifically on a 12 lead finding? If so, what were the circumstances?

I don't agree with BLS providers doing 12 leads only because why delay transport for a suspected MI to do a 12 lead only to administer oxygen and aspirin, which the BLS provider should be doing anyway if they suspect an MI. And getting an accurate reading is quite difficult to do in a moving ambulance without a great deal of artifact.

Edited March 30, 2010 by JJB531

[WAS967 97]

I have made changes in my destination based on the results of a 12-lead. I had a patient with acute MI with HUGE ST elevations and reciprocal changes. Based on the 12-lead we decided to transport to a PCI center over a local non-PCI ER (with M/C consultation of course).

The Hudson Valley region recently passed a protocol update that gave field providers the ability to transport to a PCI capable center if they found indications for such on exam. That directive was unfortunately rescinded as it needs to go through SEMAC approval first. Look for said approval to be coming (hopefully) shortly. One can only hope that the state gets on the ball and makes it protocol to divert to a "heart care" center just like we are able to divert to trauma or stroke centers. (Tho who ISN'T a stroke center anymore?).

Edited March 30, 2010 by WAS967

[Hatchet67 0]

The service I am with requires all 12 leads to be transmitted to the ED. We initate a "code STEMI" if we see one, letting us by-pass the ED and go directly to the cath lab. As for altering treatment; I will withhold any NTG with indication of a right sided infarct until I have IV access established. The fire department I work for also uses LP-12's and just purchased a LP-15.

[ny10570 745]

Since NY still won't designate PCI centers as specialty referrals we have to go through medical control. It also allows us to transmit our 12 leads to the receiving hospital and activate the cath lab. Sadly after years of LP-10 and 12 use, and an overwhelming number of members selecting the LP-15 over competing monitors we're switching to Philips because they have the CPR feed back monitor.