The Genesee County Medical Control Authority’s
Newsletter for EMS Providers - Also now available on line at GCMCA.org
3927 Beecher Rd Flint 48532
Office Phone 766-8898
12 lead Test for Paramedics and
coming mandatory training
As we moved into transmitting 12 Lead EKG’s to the
hospitals when there was:
A. ST” elevation ≥ 1mm in 2 contiguous leads
B. Chest pain patient with left bundle branch block
C. EMS personnel request assistance by hospital for
interpretation of ECG
D. Hospital requests ECG be sent.
we found that there were a number of barriers to the
hospitals receiving them.
The transmission’s purpose was to allow the hospital to
activate their cath lab as soon as possible. Given the
problems in transmitting them the question was raised,
could paramedics read the 12 lead findings accurately
enough that they could know to activate the hospital’s
cath lab from the field? National statistics
indicated that paramedics spotted
STEMI and ST elevations with the
same accuracy as ED staff did.
There was only one way to find
out and that was to test our
paramedics’ competency.
A
test for reading 12 lead EKGs has been
developed by the Education Committee. Dr. Michael
Jule and Dominic Foster gathered 32 12 lead strips that
cover the primary 18 types of findings. Forty
paramedics were chosen at random to take the test.
The Board of the GCMCA has mandated that all
paramedics who want to work in the county must take a
GCMCA sponsored 12 lead education program. More
information will be coming on the dates for this course
in the near future. Even if a paramedic has recently
taken a 12 lead course, all paramedics will be required
to take this course.
November 2011
Keeping Track of CE Credits
It should go without saying, but it is worth
saying anyway. It is your responsibility to keep
track of Continuing Education credits. This is
especially true for when you take trainings
outside of your agency. The state does do audits
of CE’s and will revoke the license of personnel
who cannot show that they have taken the
required number of credits. It is a good idea to
keep records on all of your CE’s for up to six
years. Just a friendly reminder.
Changes to Protocols
After a very long process, there are now
standardized treatment protocols that are in place
for all MCAs in the state. There are some
variations from one MCA to another. So,
especially if you are new to Genesee County
make sure you familiarize yourself with them.
The protocols can be accessed through our
website, gcmca.org.
New Pocket Protocol Book
Available Soon
There have been many people asking if there is a
new pocket protocol book out yet. By the time
you read this there will be!!
Many agencies are giving them
out for no charge to their
employees. We will have a
number of copies available for
$5.00. There is also an app for
the iPhone that can be obtained
through the Apple App Store or at
http://www.acidremap.com the web site of the
app creator.
New ACLS Guidelines
now in Protocol
On October 1, 2011, the new ACLS guidelines went into
effect for our county.
Every five years, the American Heart Association
evaluates available research and reviews existing first aid
and life support guidelines. The goal? To determine if
changes need to be made to improve the effectiveness of
lifesaving procedures such as advanced cardiac life
support (ACLS), pediatric advanced life support (PALS),
basic life support (BLS) and cardiopulmonary
resuscitation (CPR).
New ACLS guidelines were announced in late 2010, and
Health Education Solutions will reflect the new
recommendations to ACLS and PALS courses by January
2011.
Michael Huckabee, PhD, PA-C, director of the Union
College Physician Assistant program and curriculum
developer for Health Education Solutions, offers this
overview of the updates to ACLS standards:
A-B-C to C-A-B
The A-B-C approach (Airway-Breathing-Circulation) has
been changed to the C-A-B approach (CirculationAirway-Breathing). The emphasis is on quickly initiating
chest compressions in individuals with life-threatening
loss of heart function so that blood flow is maintained. It
primarily applies to CPR performed by a single rescuer. In
the hospital setting and with teams, management of
circulation and respirations are achieved simultaneously.
Chest compression changes
The chest compressions should depress the adult sternum
at least 2 inches, rather than the previous recommendation
of 1 ½ to 2 inches, and complete recoil of the chest is
required. The chest compressions should be performed at
a rate of at least 100 per minute, rather than the previous
recommendation of about 100 per minute, to maximize
critical blood flow. Checking for a pulse in an
unresponsive individual should now require less than 10
seconds so that chest compressions aren't delayed.
Mistakenly doing chest compressions on someone with a
pulse does little harm compared to not doing
compressions on someone without a pulse.
Quantitative Waveform Capnography
recommendation
Use of quantitative waveform capnography is
recommended for confirmation and monitoring of
endotracheal tube placement. The continuous
measurement provides the partial pressure of exhaled
carbon dioxide in mm Hg over time. Individuals requiring
endotracheal intubation are at risk of tube displacement
during transport and transfer and the continuous waveform
capnography reflects any changes. The capnography also
provides a monitor of effective chest compressions. The
return of spontaneous circulation is sometimes difficult to
assess and is clearly demonstrated on the capnography
measure by an abrupt increase in the CO2 readings.
New medication protocols
Four new medication protocols are recommended. One,
atropine is no longer recommended for routine use in the
management of pulseless electrical activity (PEA) or
asystole, due to a lack of any observed therapeutic benefit.
Two, adenosine is recommended for the treatment of
stable, undifferentiated wide-complex tachycardia when
the rhythm is regular and the QRS waveform is
monomorphic. Three, intravenous chronotropic agents are
recommended as an effective alternative to external
pacing for individuals with symptomatic or unstable
bradycardia. Finally, oxygen supplementation for
uncomplicated acute coronary syndromes is no longer
routinely indicated and should only be applied if the
oxyhemoglobin saturation is less than or equal to 94
percent.
Emergency care priorities
To avoid interruptions to chest compressions or delays in
use of defibrillators, the use of advanced airways, gaining
vascular access and administering drugs doesn't take
priority over high quality CPR and access to immediate
defibrillation.
Post-cardiac arrest care
A new section was created for Post-Cardiac Arrest Care,
emphasizing a structured interdisciplinary system of care
following a cardiac arrest. Therapeutic hypothermia
treatment and percutaneous coronary interventions, such
as coronary angiography with revascularization, should be
provided when indicated after cardiac arrest.
Genesee County Sheriff Department
Has Lucas Device.
The Sheriff’s paramedics have purchased the automated
chest compression device know as the Lucas Device. Only
one paramedic carries it, but it is known to be a highly
effective means of delivering quality CPR compressions.
The LUCAS device is an electric powered device that
automates the chest compression part of CPR.
The great benefit of this device is it never tires. Even the
most well trained EMT’s can become tired administering
CPR and that can unfortunately lead to death. The
LUCAS device automatically delivers 100 chest
compressions per minute or two 2 compressions per
second consistently. The consistent compressions of the
LUCAS device along with the use of an AED will help
the heart start beating in a regular rhythm. By automating
the compressions free up the caretakers hands to help the
patient in other aspects such as giving the patient
medication or getting the patient ready for transport.