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PERFORMANCE BENCHMARKS ACS does not always present with chest pain. In a study of more than 430,000 MI patients, 33% did not complain of it. These patients were more likely to be older, female and diabetic. It took signifcantly longer to recognize and treat their MI than with patients who complained of chest pain, and their mortality rate was twice as high.13 Another study showed 28% of STEMIs would have been missed by EMS if ECGs were only done on patients with chest pain.14 Atypical symptoms of MI include nausea, vomiting, weakness, dizziness, syncope and sweating. In many systems, however, a BLS-only response is indicated for patients who complain of these vague symptoms. Newer monitors are designed for BLS providers to transmit ECGs, and some education programs teach ECG interpretation at the BLS level, but it is still primarily an ALS function. A wide net must be cast to catch these patients, and 12-lead ECGs should be done on any patient with symptoms that could be caused by ACS. Twelve-lead ECGs have become the cornerstone of prehospital cardiac care, and lives are saved when they are incorporated into regional STEMI systems. Not only that, but EMS care has been shown to prevent second heart attacks and strokes long after patients are delivered to hospitals.1 STEMI patients deserve this treatment bundle from their EMS system, no matter what their complaint is when they call 9-1-1. Diffculty Breathing EMS treatment has also been shown to have a signifcant impact on patients who are short of breath.1 For patients with pulmonary edema caused by congestive heart failure, the 2008 Eagles benchmark paper recommends noninvasive positivepressure ventilation (usually provided with CPAP) and nitroglycerin. For every six CHF patients who receive this bundle, the need for one intubation is avoided.1 This saves patients the trauma of being intubated, the risk of infection from a mechanical ventilator and possibly admission to an ICU. For bronchospasm, the Eagles recommend that a nebulized beta-agonist, such as albuterol, be administered by the earliest-arriving trained and qualifed responder. This has been shown to provide immediate relief of symptoms and improve respiratory status.1 Another study showed patients with moderate to severe asthma attacks beneft from having IV steroids given before they reach the hospital. In a system with an average transport time of 10–20 minutes, a group of patients who received IV steroids by EMS got them one hour earlier than another group who received them at the hospital. The EMS-steroid group also had a lower hospital admission rate.15 Even if Prestan Family Pack Setting the Standard Prestan Professional CPR/AED Manikins Visit us online and watch a short video to learn more! Proudly Made in the USA 800-434-7989 | www.prestanproducts.com For More Information Circle 33 on Reader Service Card EMSWORLD.com | JUNE 2013 39