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.
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.
In Joan that part of the ECG looked like this.
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…
