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Issue link: https://emsworld.epubxp.com/i/131347
| By Bob Sullivan. BA, NREMT-P What is reasonable to expect from a community's EMS, and how should we measure it? Scenario #1 32 Scenario #2 You're an EMT dispatched for a 40-year-old male vomiting. He tells you he developed indigestion after eating, began to sweat and vomited. He also says he has diabetes and "just doesn't feel right." He denies any chest discomfort. His skin is cool and moist, and his vital signs are pulse 96, BP 154/80, RR 24 and pulse ox 96% on room air. You're concerned about the patient's appearance and wish you could do more to help him, but he does not meet a protocol that requires you to request ALS. You keep him as comfortable as possible during transport to the closest hospital, with an emesis basin nearby. Ten minutes later you arrive at a packed emergency department. The hallway is lined with patients, and more ambulance crews fll in behind you. The triage nurse quickly takes your report and directs your patient to a hallway bed. You wish him luck and wonder how long it will be before a physician sees him. You're a paramedic called for a patient with the same presentation. After checking the patient's vital signs and blood sugar, you obtain a 12-lead ECG that shows ST elevation in leads II, III and aVF, with ST depression in leads V1–V3. You suspect an ST-segment elevation myocardial infarction (STEMI). You immediately administer aspirin and request a "heart alert" at a hospital that provides 24-hour percutaneous coronary intervention (PCI). Bypassing the nearest community hospital, you start two IVs, draw blood samples, and give fuid and ondansetron for nausea. A resuscitation bay is ready for you at the packed ED while a catheterization suite is prepared. A cardiologist looks at the ECG you obtained and agrees with your assessment. She orders several stat blood tests, and the samples you drew are sent off. You wish the patient luck as he is wheeled away to the cath lab, and he thanks you for helping him. JUNE 2013 | EMSWORLD.com The needs of patients having cardiac arrests, heart attacks and seizures are the same wherever they occur, but if you've seen one EMS system in the United States, you've only seen one EMS system. The certifcation levels, experience and available procedures in one community can differ vastly from those of another system across the street. In some areas multiple paramedics are sent on every call, in others only BLS is available. Some communities send BLS ambulances to all calls and ALS only to ones believed lifethreatening. There are also wide variations in the quality of care and skills available within certifcation levels. Some BLS services perform 12-lead ECGs, and some ALS services still do not. The opening scenarios illustrate the differences in care patients with the same complaints may receive from different types of EMS systems, and the impact on their hospital courses and likely outcomes. Certain interventions are proven effec-