Il y a, il me semble, un projet qui ressemble à ça à US, impliquant l'Institut de Cardio.
Les paramédics (dans l'article) font le 12 dérivations, et sur leur interprétation seule, la salle de cathétérisme est activé. Salutations Stéphan Gascon > Kudo's to Aurora, Colorado ! > > Paramedic heart analysis increases odds of survival > > Aurora program may be model, experts say > By Sheba R. Wheeler > Denver Post Staff Writer > > Tuesday, December 03, 2002 - AURORA - A new program > in which Aurora > paramedics diagnose heart attacks while responding > to emergencies has > dramatically reduced treatment time and increased > patients' odds of > survival, officials say. > > Paramedics diagnosed George McArthur's heart attack > from the field > and were able to call ahead to the hospital to have > the cath lab > waiting for him when he arrived there by > ambulance.Some experts > predict that the Cardiac Alert program, designed by > Aurora > firefighters and paramedics, will become a national > model because it > has accomplished what cardiac-care specialists > across the country > have been unable to do: significantly trim admission > time to a > catheterization lab so a patient's blocked arteries > can be opened. > > For the past five years, paramedics across the > country, specifically > in Baltimore, Chicago and Los Angeles, have received > additional > training so they can read sophisticated new > electrocardiograms and > notify hospitals from the field that a heart-attack > victim is coming. > > But Aurora officials say their program is the only > one of its kind in > the country. The program, they say, is unique > because doctors at > three participating hospitals - unlike those in > other cities - are > trusting paramedics' field diagnoses and > incorporating them into a > much accelerated and seamless treatment program. > > "This is an early example of what the future holds - > a dramatic > integration of EMS and hospital resources," said > Norman Paradis, > University of Colorado Hospital senior medical > director and a member > of the American Heart Association. "In less than > five years, this > process will be universal." > > The effort flies in the face of conventional wisdom > about emergency > treatment. Traditionally, emergency physicians have > not accepted that > paramedics had sufficient training to accurately > diagnose heart > attacks. Rather, they relied on a process that > called for evaluation > by emergency physicians and cardiologists before > preparing for > surgery. > > In the Aurora program, Medical Center of Aurora, > University Hospital > and Columbia Rose Medical Center all mobilize their > cardiologists and > catheterization teams based on a paramedic's call > from the field. > > "There was skepticism at first about the level of > their training and > the accuracy of their EKG readings," said Ben > Honigman, University > Hospital emergency medicine division head. "It took > trial and error, > but we are at the point now where we have faith in > it. It is clear > that you can teach paramedics how to read EKGs." > > The program involves new technology - a "12-lead" > electrocardiogram, > which trumps the traditional 4-lead model commonly > used in hospitals > and which paramedics have used in the past. > > The equipment is expensive, as is the cost of > misdiagnosing a heart > attack. The Aurora Fire Department paid $18,000 each > for the 15 > machines their emergency crews now use. > > Still, the results have been very encouraging. > "Door-to-balloon > time," or the time between hospital arrival and > angioplasty, used to > be 130 minutes at Medical Center of Aurora. But the > Cardiac Alert > Program has shaved 52 minutes from the process, > dropping treatment > time to 78 minutes. > > That beats the two- to three-hour national average > and the goal of 90 > minutes, according to a study published in the > Journal of the > American Medical Association about the Cardiac Alert > Program. > > Other hospitals in the area say they are aware of > the Aurora program > and are still deciding whether its techniques are > relevant for them. > > Denver Health Medical Center does not have a > catheterization lab, but > Denver paramedics are also trained to read EKGs from > the field. > > Because of the Aurora program's success, University > Hospital also now > mobilizes its cath team based on information it > receives from Denver > field paramedics. > > Memorial Hospital in Colorado Springs considered > establishing the > program there but eventually decided against it, > said hospital > spokesman Chris Valentine. Staff there say their > patient transport > time is a lot faster than in Denver because their > community is > smaller. > > In Aurora, about 100 patients have been through the > Cardiac Alert > Program; five had their hearts stop during the > process. But all lived > and walked out of the hospital. > > "We have decreased their heart attacks, their > complications from > heart attacks, and improved their heart function and > survival," said > Nelson Prager, the medical center's cardiology > chief. > > In surviving a heart attack, experts say, time is a > critical factor. > The Journal of the American Medical Association says > that only 30 to > 40 percent of patients receive angioplasty treatment > within 90 > minutes of suffering a heart attack. The death rate > for patients not > treated within that window of time increases between > 41 percent and > 60 percent, the journal says. > > "Time is (heart) muscle," said Jana Williams, the > EMS and Trauma > program director at Medical Center of Aurora. "The > quicker we are all > moving to get that patient into the cath lab for > definitive care, the > better the patient's outcome." > > George McArthur, a 59-year-old hazardous materials > worker, credits > the program and the teamwork of paramedics and > hospital staff for > saving his life. > > McArthur was driving home the morning of Aug. 5 when > a pulsating pain > ripped across his chest. By the time he made it > home, he was > sweating, nauseated, dizzy and exhausted - classic > symptoms of a > heart attack. > > Paramedics arrived within minutes, asking him > questions, hooking him > up to monitors. > > "I made a remark that I hoped it wasn't a false call > or something, > that this was the real McCoy," McArthur said. > > It was. Doctors and nurses were ready for him when > he arrived at the > hospital due to their streamlined process - complete > with assigned > roles, check-off lists and prepackaged medications. > > "The first call went out at 10:11 a.m., and they > were done by 1 p.m. > And that's with the angioplasty taking 45 minutes," > McArthur said. > "Each person knew exactly what they were doing. > There was no > backtracking or repeating. That gave me confidence > that I was getting > the best of help." > > In the past, say paramedics participating in the > Aurora program, > their EKG readings and other heart-attack field > diagnoses were > ignored. > > "We'd take the 12-lead EKG and call ahead to tell > the emergency > physicians to get the cath lab ready," said Scott > Wifall, an Aurora > firefighter and paramedic. "But they would disregard > information." > > Once the patient reached the hospital, staff would > repeat what > paramedics already had done. A cath lab, which is > not staffed 24 > hours, would not be called until an emergency > physician evaluated the > patient. More time would be lost waiting for a > cardiologist and his > team to get to the hospital and prep for receiving > the patient. > > "The trust factor wasn't there," said Gene Eby, > Aurora fire's medical > director and emergency physician at Porter and > Littleton hospitals. > "The technology was being wasted, and both sides > lost faith in the > 12-lead program. Paramedics had very little > incentive, and they > didn't feel like they were doing anything to impact > patient care." > > Assembling a cath lab costs hospitals thousands of > dollars, making > false calls expensive mistakes to choke down. > > "The only way to instill emergency physicians' > confidence in the > program was by constant review and refining of the > process," said > Gilbert Pineda, the EMS director at Medical Center > of Aurora. "We > deal with too many agencies now that routinely cry > wolf. They say > they have a heart attack victim and they don't even > have EKG > capabilities. We have a greater sense of trust in > Aurora's program > because of their education and tight quality > assurance." > > Eby's staff developed a quality-assurance process > that included 16 > hours of training for identifying the classic > symptoms of a heart > attack, in addition to interpreting 12-lead EKG > readings. > > The program was tested in September. An initial goal > was set: If > paramedics could not make an accurate heart attack > identification at > least 90 percent of the time, Cardiac Alert would be > discontinued. > > In the first three months, paramedics made the > correct call only 82 > percent of the time, Eby said. Eby told Medical > South doctors the > program had failed. But the doctors, having already > seen improvement > in cardiac care, agreed to keep the program going. > > Eby was able to convince emergency physicians at > University and Rose > hospitals the program was worthwhile. > > Mistakes are still made. The Cardiac Alert program > now has an 85 > percent accuracy rate - still below the 90 percent > goal, but good > enough to satisfy officials that the program is > worthwhile. > > Technology is being developed that would allow > paramedics to transmit > 12-lead EKG readings to emergency physicians via > dedicated radio and > cellphone lines. > > Paradis said that will improve Cardiac Alert's > accuracy. > > "It has been shown that the occasional errors are > more than > outweighed by the patients in which we get it > right," said Paradis, > senior medical director at University Hospital, > which has received > about half a dozen heart attack victims from Aurora > paramedics. > "They've been right every time they've brought > patients to us." > > ______________________________________________________________________ Post your free ad now! http://personals.yahoo.ca --- SMU-L Le petit compendium 2003 - Guide de reference sur les medicaments en comprimes et par inhalation (+ de 1150 medicaments; reference C.P.S. 2003). 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