Thursday, September 23, 2010

A Standard of Care

After a great discussion on EMS Garage last week in relation to these articles, I thought I would go a bit further.

A recent article on Jems.Com discussed the Salt Lake City Fire acquiring the brand new technology of 12 Lead EKG. Really? New technology? It is something the citizens of Salt Lake City should expect from those providing emergency care. But, why has it taken them so long to obtain this equipment. In looking at their website, the Fire Department does not provide patient transport. That is provided by a private company contracted by the city. The article states that they are "working together" to use this new technology. Was the private service performing 12 leads prior to this? I surely hope so. I really enjoyed the quote "time is money". I do hope he meant to say "time is muscle", or the reporter misquoted him. Without all of the facts, it appears that the city is catching up with the modern care and treatment for cardiac patients. Which is more than I can say about the following article which talks about Chicago EMS not having the capability to obtain a 12 lead.

The next article is from last year, but relates closely with the previous. Chicago Behind the times in heart attack response.

Yes, this article is old. However, I recently heard from a reliable source that they still do not have 12 Lead capabilities. I do not enjoy "be-rating" another agency, but…I found this article surprising, yet I was aware of these facts. It is hard to believe that an EMS agency this size, in this day and time, could be so behind. If I were a Chicago taxpayer, I would be outraged. EMS systems in much smaller areas and operating with a far smaller budget have the technology and are using it. 75 ALS ambulances…and not one have 12 lead capabilities. I would also be concerned as to what other forms of treatment are lacking.


The phrase "times is muscle" apparently has never been uttered in Chicago EMS. From the AHA to any current trade magazine or conference, the "Stemi" is still a discussion topic. There is a lot of research and many services and hospitals are "bragging" about their improvements in d2b (door to balloon time). There is little we can do to "save" the patient in these situations. The patient needs definitive care. The patient needs a cath lab.


How can Levinson say that patient care has not suffered? If a patient is having an MI, care is compromised. The 12 lead ECG is now considered a standard of care. Levinson states the cost to upgrade is $4 million. Only 1 % of the department's budget. Really… they could not spend this money on the new monitors and education? Are the hospitals in the metro area not willing to help out with the cost? It states the money was there, but then used for other operational needs. I am curious as to what those needs were.


In the 2007 and 2009 "State of Science" supplements in JEMS, Chicago was a NO for 12 lead, CPAP, and IO. The 2009 supplement also had Chicago listed as a NO for Therapeutic Hypothermia and Intranasal medication administration. After reading this insert from JEMS, I expected Chicago would move forward with the times and begin to implement current technology and treatments into their system to improve upon patient care. Two years have passed, and still no 12 lead. Is their theory that they will just drive fast to the hospital?


This article sheds light on the fact that because you are in a major metropolitan city does not mean you will get modern care and treatment.



  1. That's crazy.

    I currently ride with a volunteer EMS agency in suburban Virginia. We've been doing 12-leads for YEARS, have been using capnography for nearly as long, and added therapeutic hypothermia and CPAP about two years ago.

    If we can do it, I'm dumbfounded why a large agency like Chicago Fire can't.


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