Through the years, I have sat through countless ceremonies honoring those who have saved lives while performing EMS. Usually, the ceremonies center on those who have suffered cardiac arrest and were brought back from the brink of death, and then go on to lead a normal life. What is really...
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Through the years, I have sat through countless ceremonies honoring those who have saved lives while performing EMS. Usually, the ceremonies center on those who have suffered cardiac arrest and were brought back from the brink of death, and then go on to lead a normal life.
What is really emotional is when victims are reunited with their rescuers for the first time. There is usually not a dry eye in the place. I remember a ceremony in St. Louis, where a high school-age victim and his parents met the paramedics for the first time. Even the mayor of St. Louis needed some tissues to dry his eyes.
It continues to vex me since more and more it appears that the naysayers continue to advocate going back to the scoop-and-run days of yesteryear because, they contend, providing advanced life support (ALS) care in the field has no benefit and can be costly. The scoop-and-run theory relied on rapid transport by responders with little or no medical training. This philosophy proved to have very little value to the patient.
Now, the new buzzword is "evidence-based medicine." Those who push for evidence-based medicine advocate doing procedures and protocols based on whether there is truly any advantage to the patient based on outcome studies. Several recent studies have tried to prove that paramedics and ALS systems make no difference. Earlier this year, a group of civilians in Columbus, OH, commissioned to look for budget-cutting opportunities found a study saying that there was no value in ALS delivery and made a recommendation to make the entire Columbus Fire Department a basic life support (BLS) system. Unfortunately, these civilians had no fire or EMS background and thankfully their recommendation did not fly.
Now there is mounting evidence in the form of the studies that prove that EMS is valuable in STEMIs, stroke management, respiratory and trauma emergencies, and sudden cardiac arrest.
Let's look at STEMIs, or ST elevated myocardial infarctions. A 2007 study found that STEMIs account for 4% to 5% of all chest pain calls and a majority of STEMI deaths occur within two hours. That is why there is a benchmark of inserting a balloon in a blocked artery within 90 minutes.
A study done in 2008 clearly demonstrated benefits to patients in EMS systems where paramedics have 12-lead EKG capability and can interpret 12-lead EKGs versus EMS systems where paramedics do not have such capability. The one study done in Ontario, Canada, showed a median time of 44 minutes was saved with thrombolytic care where paramedics were able to make the EKG interpretation in the field. Another study done in the Netherlands proved the same results with better patient outcomes in 95% of acute STEMIs.
Another study done in 2008 showed an approximate 10-minute decrease in door-to-drug time and 15 to 20 minutes in door-to-balloon time for patients who used an EMS system versus those patients who arrived in the emergency department on their own. This study did not calculate the time saved in the more aggressive EMS systems where ambulances bypass the emergency room and go directly to a cardiac catheterization laboratory. However, one study done in Germany with an aggressive EMS system showed a decrease in door-to-balloon time from 54 minutes to 26 minutes — or a 54% reduction. Another study done in Concord, NC, showed that when an on-call cardiologist was able to interpret EKGs transmitted by EMS in the field, there was an advantage to the patient. In that study, door-to-balloon times decreased from 101 minutes to 50 minutes. A study in Newark, NJ, saw door-to-balloon times reduced from an average of 146 minutes to 80 minutes.
In more aggressive and well-trained EMS systems, paramedics who do in-field interpretations of EKGs are bypassing the closest hospital and taking the patient to the closest most-appropriate facility. In the case of STEMIs, it is usually a hospital that has a cardiac cath lab and can do percutaneous coronary interventions (PCIs).
In a study done in Medford, OR, protocols were created to direct all STEMI patients to a single PCI hospital. In total, 233 patients were brought in by EMS or walked into the hospital. Researchers looked at PCI reperfusion and in-hospital mortality. Overall hospital mortality was 2.1% with these 233 patients and zero among those patients brought in by paramedics.
A 2004 study in Dijon, France, was done to determine "the impact of an emergency medical services call on the management of acute myocardial infarction, considering time intervals for intervention and revascularization procedures." This study showed that the majority of the population underutilized EMS when they had symptoms of myocardial infarction. At the same time, the study showed the benefits to those using EMS in reducing hospital delays and obtaining revascularization much faster.
Countless studies leave little doubt that EMS and paramedics add tremendous benefit to the community. For those who see no advantages to our current EMS systems, I say, sit through a live-saving ceremony. Maybe like the mayor of St. Louis, you'll see some high school kid who was dead go on to graduate with his class.
GARY LUDWIG, MS, EMT-P, a Firehouse® contributing editor, is a deputy fire chief with the Memphis, TN, Fire Department. He has 32 years of fire-rescue service experience. Ludwig is chairman of the EMS Section for the International Association of Fire Chiefs (IAFC), has a master's degree in business and management, and is a licensed paramedic. He is a frequent speaker at EMS and fire conferences nationally and internationally, and can be reached through his website at www.garyludwig.com.