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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EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation
Comments
Brooks Walsh MD
“Bad heartburn” – 82 y.o. female without chest pain.
The option was indeed turned on! As for non-CP presentations of ACS, I absolutely believe that these warrant the same level of urgency as the "typical" presentations. Both men and women, young and old, all commonly present without classic chest pain. Besides, how much difference is there between "burning in the epigastrium," and "pain in…
2014-08-21 17:10:37
Austin
“Bad heartburn” – 82 y.o. female without chest pain.
You took the words right off of my keyboard, Jason! A little bit of critical thinking works wonders when faced with "protocol versus best interests of the patient" type decisions. Not to encourage deviation from protocols and such, but it is a much less severe trespass if you bend the rules a bit as long…
2014-08-21 16:33:27
Brooks Walsh MD
“Bad heartburn” – 82 y.o. female without chest pain.
My uninformed opinion? I pretty much agree with AHA - if they aren't hypoxic, no need. I'm not sure how terrible superoxia really is, short-term, but why bother if it doesn't help?
2014-08-21 16:31:05
jason
“Bad heartburn” – 82 y.o. female without chest pain.
Chris Watford- as you probably know the "acute MI suspected" detection function in the LP12/15 is a programable option. I suspect the software didn't miss this but rather it wasn't turned on. As for treatment everyone has pretty much got it down. Finally as for activation. Absolutely! Don't real care if the protocol allows for…
2014-08-21 16:30:34
Austin
“Bad heartburn” – 82 y.o. female without chest pain.
There's not much I think I can add at this point, but I will comment on a couple of things. The reciprocal changes indicate to me that there is likely RCA involvement. Also, I've recently been hearing quite a bit about withholding O2 in ACS patients like this. Dr. Walsh, do you have any opinions…
2014-08-21 16:23:21

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