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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Comments
michelle
68 Year Old Male: Chest Tightness – Part 1
i see some depression and slight elevation in the st segment in the avr. i would alert the stemi crew to stand by.
2015-07-27 17:15:03
sean morrison
68 Year Old Male: Chest Tightness – Part 1
It's the big one Weezy! LAD
2015-07-27 12:48:03
Ryan Lord
68 Year Old Male: Chest Tightness – Part 1
Had the exact same last night but a known AF patient pain commenced after 2 hours of palpitations and described as like a previous MI. Her rate was up at around the 160 mark... Had the widespread depression but elevated aVR and V1. Discussed with Cath Lab and preceded to A&E next door for review,…
2015-07-27 12:14:23
Brendan
63 Year Old Female, CC: Neck and Arm Pain
Everyone providing oxygen should try and read the results of the AVOID trial...
2015-07-27 03:15:56
Brooks Walsh MD
Computer misses it, but the medic catches it.
Well this blog is a great place to start! We cover most every aspect of emergency electrocardiography, with a variety of authors, and multiple perspectives, usually in a clinical context. If it is a book you are looking for, I prefer Ken Grauer's. I started with Dr Grauer as a paramedic student and I still…
2015-07-27 01:45:18

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