Joan #3

The EMT (Emergency Medical Technician – like a Paramedic, only not paid as well…) was very relieved to see the familiar yellow form of an ambulance pull up outside Joan’s house.  He went and opened the door, and mimed pushing a wheelchair to the crew getting out of the vehicle.

There are a couple of ways to lose your job working for the ambulance service, one of these ways is to walk a ‘chest pain’ out to your ambulance.  The patient goes on our carry chair, and straight onto the trolley in the back of the ambulance.

The EMT finished telling the crew all that he had discovered, the crew, not being stupid, also only needed to take one look at Joan to realise that she was seriously ill.

They wheeled her quickly to the ambulance, where they explained that they were going to take a look at what Joan’s heart was doing.  Joan didn’t care that they wanted to put sticky dots on her naked chest, she was feeling too ill to worry about being topless.

One of the things that we in a London Ambulance Service can do is a “12 lead ECG”, this is a detailed electrical reading of the hearts activity.  We need to get the patient topless, then stick a number of electrodes to the front of the patient’s chest.  The machine then prints out a pretty little picture of what is happening with the patient’s heart.  Joan’s looked a little like this.

An ECG showing an acute MI

The real skill comes from understanding what all those squiggly lines mean.  We run a two day ECG reading course, where we are taught to recognise the seriously bad things that can happen to someone’s heart.  When we first trialed the reading of ECGs there was a test between the ambulance crews and the junior accident and emergency doctors.  The ambulance crews got more ECG interpretations right than the doctors.

Twice…

In Joan we are looking for something called the ‘ST Segment’. 

In a normal healthy ECG this part of the line should look like this.

Normal ST Segment

In Joan that part of the ECG looked like this.

Raised ST Segment          Annotated raised ST segment

Can you see how the rightmost part seems raised?  This is one of the signs of a heart attack.  For us it is a ‘red flag’ that tells us to get the patient to hospital in as quick a fashion as possible.

The ECG machine spat out a pink piece of paper.  The ambulance crew both read what it meant immediately.  Joan was having a confirmed heart attack.

The driver went through the cabs dividing door an sat in the driving seat, she started the engine and hit the ‘priority’ button on the radio.

J201 calling priority, go ahead”, came the voice over the radio.

Afternoon”, the driver said into the mike, “Can you show us Blue into Newham hospital, we have an eighty two year old woman with confirmed MI via ECG, BP is 88 over 50, pulse is 40, O2 sats are 99 on O2, BM is 5.2 and our ETA is two minutes”.

The radio operator repeated it all back to the driver, and finished with, “that’s being done for you now”.

The ambulance attendant was sitting in the back, keeping a watchful eye on Joan, while explaining that they were going to use the sirens to get Joan to hospital, and that when they got there she was going to be the centre of attention for a lot of doctors and nurses.

The ambulance pulled away, blue lights flashing and the driver gave a quick wave to the Rapid Responder who was finishing up both his paperwork and the cup of tea he had in a travel mug.

Now that ambulance crews can interpret the heart tracing of an ECG we have two options as to which hospital the patient can go to.  We can run them to the nearest hospital, where they will receive a drug to break up the clot in their heart, or we now have the choice of taking the patient to the nearest hospital that provides a primary angioplasty service.  An angioplasty is a medical way of opening up the blocked heart artery.

…but more on that tomorrow…

18 thoughts on “Joan #3”

  1. Thanks for posting this- I have a very stubborn husband who I believe had a heart attack, but absolutely refused to go in for it- now I know what the eeg should look like, it would help if it happens again. I plan to call the emt's next time no matter what he says. Her symptoms mirrored his.I really appreciate your blog, and love reading your regular, off the cuff posts. This one is really informative! Thanks!

    Mrs. Clayton

  2. Really enjoying these posts, not too long so I don't lose interest and written in a way which give all the facts but doesn't blind me with science.The only bit I didn't follow is “BM is 5.2”, what does that mean?

    Steve

  3. “BM” is a measure of the amount of sugar in a patient's blood. It's a standard test for our patients……Actually, you've just reminded me of something I need to post about.

    Wait until then, and all will be explained.

  4. I know, I read it, but there's still something that's troubling me. I don't really want to ask it publicly, is there any chance that I could email you?

  5. BM is a commonly used test for diabetics to monitor blood sugar levels ie if a diabetic is hypo it will be below 4. We record BMs in suspected or confimed cardiac events as it has been suggested that these tend to rise with the event.

  6. Yay!Joan's going to hospital!

    The handsome, heroic EMT (Emergency Medical Technician like a Paramedic, only not paid as well) got a cup of tea!

    That's me happy!

  7. Stupid question, but in cases like Joan's, what do you do about the house?Living alone, guess you can't ask her to stop on the way to the ambulance and lock the door… but surely the EMT from the FRU can't wait around til friend or family arrives to sort it out?

    I mean living in Newham it's bound to be an issue right? You can't just leave houses open like that?

  8. criticism: I prefered the first Joan post to this one. I think because you were less silly about yourself (tall, dark, handsome, underpaid) which I think detracts from the story you're telling in this instance.

  9. Well, we normally find the house keys, lock up behind the patient and then hand the keys to the patient.This is often my job while the crew look after the patient.

  10. Your interpretation of the ECG can include not only that, yes, she is having an MI, but can also localize the part of the heart affected. Looks like Joan might be having an anterior wall MI – not good for Joan. In the UK, how prevalent is heart bypass surgery? Do you have the option to take Joan to a facility that can perform heart surgery if deemed needed or are less invasive measures like clot busting or angioplasty always tried first?

  11. I feel driven as only a retired EMT could be that the term Paramedic should be applied to all emergency ambulance personnel. Your comment like a paramedic but not paid as well, just about sums it up! The difference between an experienced Paramedic and technician in the UK is a three month sandwich course paid for by the London Ambulance Service. Why the Service adopted these differing terminologies has always baffled me. In so far as the paramedic has additional skills and knowledge commensurate to a sandwich course, it doesnt amount to a great deal to the suspended patient. Its a heart start and solid professional CPR that really counts when technically all is lost. I always found that at a trauma call it was I as the EMT that took overall responsibility in what is the control and management of an emergency situation! The Paramedic was always too busy spiking the patient and drawing up medication and drug infusions. I always regarded the introduction of these separate terminologies as a slap in the face and its about time they got back to a more correct formulation. Every month when I received my wage slip as you do today, I was paid for paramedic skills, so why cant they acknowledge that by utilising the Paramedic, Qualified Paramedic terminology. This would more clearly reflect the reality of ambulance service tasks and anyway a so called Emergency Medical Technician is only some-one still on the journey, to becoming a fully qualified Paramedic!

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