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!
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