Congratulations to Dr. Michel LeMay

Congratulations are in order for Dr. Michel LeMay of the Universtiy of Ottawa Heart Institute. He was recently one of eight Canadians recognized with an award from the Canadian Institute of Health Research (CIHR) and the Canadian Medical Association Journal (CMAJ) for “developing a new way to handle heart attacks that empowers paramedics to read electrocardiograms and identifies patients with blocked arteries who need to be fast-tracked to angioplasty surgery — reducing mortality by 50%.”

“Itís worth noting that all the winners of this new award have placed a strong emphasis on translating their research discoveries and knowledge into innovations that have resulted in practical ways to improve health outcomes,” said Dr. Ian Graham, Vice President, Knowledge Translation at CIHR. “Thatís a crucial test for health research; how can it make a difference in peopleís lives.”

Of note, the Ottawa Paramedic Service is one of the few EMS systems I’m aware of, and definitely the largest, where the computerized interpretations are turned off. The paramedics are solely responsible for interpreting the ECG correctly (no transmission of the ECG required) and it’s obvious they’re doing a fantastic job with a cadre of highly trained prehospital professionals.

From LUMEN 2009 Workshops Highlight Pertinent Issues in STEMI Interventions Cath Lab Digest 2009; Volume: 17, Issue 2:

The Ottawa STEMI program attributes its success also to its advanced paramedics. Can you share with us more information about the role these paramedics play and the process undertaken to train them?

“We have two types of paramedics who attend land ambulances in the city of Ottawa: the primary care paramedic (PCP) and the advanced care paramedic (ACP). Community colleges in the province of Ontario offer PCP and ACP diplomas. The requisite training is two and three years, respectively. The training program emphasizes anatomy, physiology, pharmacology, and mechanisms involved in acute injury and illness. Upon course completion, the graduating PCP is required to write a provincial certification exam called the Advanced Emergency Medical Care Assistant (AEMCA) exam. The PCP skill sets include semi-automatic defibrillation, administration of medication such as aspirin, epinephrine and nitro spray, initiation of peripheral IVs, and the application of the 12-lead EKG. The ACP needs a minimum of 2 years of experience in the field to qualify for training at the ACP level. The ACP program requires an additional one year of training in the classroom and in the hospital. The ACP skill set includes airway management (orotracheal and nasotracheal intubation), pharmaceutical therapy such as lidocaine, atropine, dopamine, and fentanyl, treatment of cardiac emergencies according to advanced cardiac life support (ACLS) guidelines, and 12-lead EKG interpretation. Training ACPs to read EKGs for the detection of STEMIs in Ottawa requires 2-3 hours of classroom teaching followed by a written exam. We now train the PCPs as well at interpreting EKGs for STEMIs. It has now become standard practice in Ottawa for all paramedics to interpret EKGs in the field and independently initiate transfer to the Ottawa Heart Institute for primary PCI.”

Quite a contrast to paramedic education in the United States.

Well done, Dr. LeMay!

See also:

Comparison of early mortality of paramedic-diagnosed ST-segment elevation myocardial infarction with immediate transport to a designated primary percutaneous coronary intervention center to that of similar patients transported to the nearest hospital.

Photo credit: Cath Lab Digest

5 Comments

  • Shaggy says:

    There is a big difference in the educational requirements, and there is a lot of politics involved that includes the fire service and volunteers. Let's not go there but advocate anyway to at least meet the same standards as countries like the UK, Canada and Australia. It is embarrassing that we rely on medics who find it difficult to just get through a less than year long vocational paramedic mill while other countries rely on college educated medics. And we want to be looked at as medical professionals. I know, this is a whole other debate.

  • SoCal Medic says:

    Kudo's to Dr. LeMay. You have to appreciate someone who throws down the challenge and gets people to rise to the occasion, not just once, but regularly. I agree with Shaggy, the educational requirements of paramedics can be debated to no end, but it is nice to see people recognized for stepping up to the plate. Great Work!

  • akroeze says:

    Back in May I was in a position to receive a full time job with Ottawa, or my current service. Obviously I chose my current service.Ottawa is VERY progressive in a lot of ways and truly supports independently thinking medics. Fortunately I work under the same base hospital as they do so some of that trickles down to us here (although not enough I must say!). Currently if the LP12 reads ***ACUTE MI SUSPECTED*** or the ACP (ACP only) diagnoses STEMI we head to the local hospital at the highest triage level (CTAS 1) and unload the patient into the doors of the ER. We are met by the MD who has 5 minutes to decide if the patient will be going to the cath lab. If they are then we have to have left the hospital again within 10 minutes. In that time they will have given the patient Plavix, Heparin bolus, and possibly TNK (I'm pretty sure it is only if the onset is less than one hour). We then proceed directly to the cath lab and unload the patient onto their table.It does seem unecessary but perhaps there is some evidence that patients with a longer transport time benefit from TNK first then PCI? Someone educate me on this?For reference our transport time to the PCI centre is about 50-60 minutes.It is rumoured (although like any service there are more than enough to go around) that they will be turning off the automatic interpretation algorithm on our LP12s in the near future. Hope this means they will be trusting the PCPs to interpret.

  • Anonymous says:

    I work for North Memorial Ambulance in Minnesota, we service a large portion of the Twin Cities (Minneapolis and suburbs). For quite a few years we have had the automatic interpretations turned. We also can field activate the Cath Lab based on our interpretation of the EKG and provided the Cath Lab is prepared upon our arrival we go straight up. If they haven't had enough lead time to be ready just yet we make a quick stop in the STAB room.

  • Tom B says:

    Anonymous – What's the STAB room?Tom

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