Subject(s)
Emergency Medical Services , Stroke/diagnosis , Diagnosis, Differential , Diagnostic Errors/prevention & control , Epilepsy/diagnosis , Epilepsy/physiopathology , Humans , Hyperglycemia/diagnosis , Hyperglycemia/physiopathology , Hypoglycemia/diagnosis , Hypoglycemia/physiopathology , Migraine with Aura/diagnosis , Migraine with Aura/physiopathology , United StatesABSTRACT
40-year-old man is washing windows on a scaffold outside of an office building about 28 feet above the sidewalk when a support rope fails and one side of the platform drops. His safety harness works as designed and prevents him from falling more than a few feet. The straps around his legs pull tight, and he's a little sore from the sudden jerking halt of his fall, but he's not seriously injured. A pedestrian on the street hears the falling scaffold and the man's fearful yell and immediately calls 9-1-1. Rescue units arrive at street-level in six minutes to find the worker dangling above the sidewalk. They immediately set out to rescue him through the office windows, thinking it will take only about 10 minutes to bring him in safely.
Subject(s)
Accidental Falls , Blood Circulation/physiology , Emergency Medical Services , Hypotension, Orthostatic/physiopathology , Protective Devices , Syncope/physiopathology , Humans , SyndromeABSTRACT
INTRODUCTION: The prehospital 12-lead electrocardiogram (ECG) has become a standard of care. For the prehospital 12-lead ECG to be useful clinically, however, cardiologists and emergency physicians (EP) must view the test as useful. This study measured physician attitudes about the prehospital 12-lead ECG. HYPOTHESIS: This study tested the hypothesis that physicians had "no opinion" regarding the prehospital 12-lead ECG. METHODS: An anonymous survey was conducted to measure EP and cardiologist attitudes toward prehospital 12-lead ECGs. Hypothesis tests against "no opinion" (VAS = 50 mm) were made with 95% confidence intervals (CIs), and intergroup comparisons were made with the Student's t-test. RESULTS: Seventy-one of 87 (81.6%) surveys were returned. Twenty-five (67.6%) cardiologists responded and 45 (90%) EPs responded. Both groups of physicians viewed prehospital 12-lead ECGs as beneficial (mean = 69 mm; 95% CI = 65-74 mm). All physicians perceived that ECGs positively influence preparation of staff (mean = 63 mm; 95% CI = 60-72 mm) and that ECGs transmitted to hospitals would be beneficial (mean = 66 mm; 95% CI = 60-72 mm). Cardiologists had more favorable opinions than did EPs. The ability of paramedics to interpret ECGs was not seen as important (mean = 50 mm; 95% CI = 43-56 mm). The justifiable increase in field time was perceived to be 3.2 minutes (95% CI = 2.7-3.8 minutes), with 23 (32.8%) preferring that it be done on scene, 46 (65.7%) during transport, and one (1.4%) not at all. CONCLUSIONS: Prehospital 12-lead ECGs generally are perceived as worthwhile by cardiologists and EPs. Cardiologists have a higher opinion of the value and utility of field ECGs. Since the reduction in mortality from the 12-lead ECG is small, it is likely that positive physician attitudes are attributable to other factors.
