Le Mercredi, 4 déce 2002, à 00:42 America/Montreal, Stephan Gascon a écrit :
Il y a, il me semble, un projet qui ressemble ‡ Áa ‡ US, impliquant l'Institut de Cardio.Les paramÈdics (dans l'article) font le 12 dÈrivations, et sur leur interprÈtation seule, la salle de cathÈtÈrisme est activÈ. Salutations StÈphan GasconKudo'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). Cout: $10.00 l'unite, $1.00 sera remis a une fondation pour enfants malades. Courriel: [EMAIL PROTECTED] Site web: www.urgence.qc.ca/compendium
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