Are You Up for the E2B Challenge?

In the October 2008 issue of Emergency Medical Services, our very good friend Ivan Rokos, MD makes some comments that are worth repeating.

“[P]aramedics are now in a novel role, where they are able to diagnose STEMI faster and earlier than ever before using a prehospital EKG machine. This is important for two reasons: One is that hospital ED overcrowding has become a big issue and it’s sometimes challenging for a walk-in STEMI patient to have an EKG in a timely manner in an ED where staff and beds are pushed to the limit. In contrast, paramedics provide one-on-one care, so they can do a prehospital EKG very quickly. The second thing is that it’s increasingly recognized that a prehospital EKG done in isolation means nothing unless it’s acted upon by the receiving hospital, which can get its ED, cardiac cath lab and ICU ready to receive the patient when he arrives…”

“It’s very exciting in 2008 that paramedics are in a unique position to trigger a whole cascade of events that can make a big difference in a STEMI patient’s life,” says Rokos. “Basically, the clock has always started at the hospital door. The current cardiology guidelines recommend that the blocked artery should be open within 90 minutes from the hospital door to balloon inflation, but we want to push it up another notch, raise the bar on perfusion speed and set the clock not at the hospital door, but in the patient’s living room or office, or wherever the prehospital EKG shows a STEMI. That is the idea of the E2B Challenge.”

Are you up for the E2B Challenge? Join the E2B listserv here.

2 Comments

  • KT says:

    Are we to measure the "E" in E2B as the first field ECG and not time at scene? How do you measure the full process if we don't measure on scene to balloon?

  • Tom B says:

    KT – You are correct in that the consensus seems to be moving toward 9-1-1 call or arrival on scene.The argument for E=ECG was that we measured "discovery" to treatment. But what if EMS fails to perform a PH12ECG?Tom

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Thanks for writing Tyler. They are the same thing. Strain pattern is just the result of increased pressures against the ventricles which alters the way repolarization occurs from epicardium to endocardium. Similar to stepping on a puddle of water. Your show spreads the water away from the area of pressure. The ST segment is slightly…
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Tyler
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Can you explain how these ST segment and T wave changes can be differentiated from right strain pattern?
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