Maryland medical journal (Baltimore, Md. : 1985)
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Emergency Medical Services-Early Heart Attack Care (EMS-EHAC) is a community-based program where paramedics increase the consumer's awareness about early chest pain symptom recognition. EMS-EHAC prevention, along with seamless chest pain care (between the paramedic and chest pain emergency department) can be the basis for an outcome-based study to examine the impact of advanced life support EMS. ⋯ If significant benefits of ALS care cannot be demonstrated, the cost differences could potentially place the future of advanced life support paramedic programs in jeopardy. A positive outcome resulting in a lower acute cardiac event, and the realization of the cost benefits from the EMS-EHAC program could be utilized by EMS management to justify or expand advanced life support programs.
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Comparative Study
An eight-month evaluation of prehospital 12-lead electrocardiogram monitoring in Baltimore County.
The purpose of this evaluation was to determine if a prehospital 12-lead electrocardiogram (ECG) led to a delay in transportation when compared to non-12-lead ECG, and if it led to improved "door to drug" time. A quasi-experimental design was used to compare on-scene times for suspected acute myocardial infarction (AMI) patients; a comparison was made between advanced life support (ALS) units without 12-lead ECG and those who were augmented by equipped EMS district officer units. Our control group had an on-scene time of 22.05 minutes; the mean on-scene time for the experimental group was 21.85 minutes. The results of this study indicated that 12-lead ECG acquisition by district officers did not extend the on-scene time.
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It would be impossible to expect that an immediate solution to the heart attack problem in the United States can come out of this multidisciplinary conference. A more practical goal would be the conferees coming together, seeing better what needs to be done, and using interpretative abilities to put together a logical approach which would unite both the community hospital and the community by the first step on the learning curve. ⋯ Acting locally and thinking globally will enable us to move forth and find the expectations of each member of the team. The challenge will find us many times in the years ahead.
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Saint Joseph Medical Center has had two years experience with operating a chest pain center (CPC) in its emergency department. The CPC has resulted in improved treatment for patients with myocardial infarction. The CPC has led to the utilization of primary angioplasty as a preferred strategy for acute myocardial infarction. The CPC has allowed rapid rule-out of acute coronary syndromes in the emergency department thereby avoiding hospital admission in 31% of patients with chest pain of possible cardiac origin.
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Patients experiencing ischemic chest pain represent one of the most common emergencies in prehospital emergency medical service (EMS) systems. Recent national guidelines for emergency department and EMS care of chest pain and acute myocardial infarction (AMI) patients have quantified standards for time to evaluation and treatment. Prehospital EMS systems and hospitals will need to change their processes of care for chest pain patients to meet or exceed these national guidelines. ⋯ Based upon the information gathered and considering qualities essential to future performance, the task force made recommendations for changes to Howard County's EMS system. This study reports the task force recommendations and describes those implemented thus far. Changes to the EMS system are quantified, descriptive data from the system are reported, and future goals are presented.