[MEDIC6958]

dygear thanks again

Interesting when you look at the list there are no cath lab east of the meadowbrook parkway.....

[taximedic234]

That should be food for thought for all EMS agencies in the eastern part of nassau. THis should be voiced to remsco before the protocol is in place. and also EMS agencies should come up with a plan for their bus going from say Massapequa to Winthrop or South. or for Plainview jumping on the parkway to N. Shore.. It will be tying up your bus for a bit longer. It also means we have to lobby the hospitals to expidite triage and those patients with legit STEMI need IMMEDIATE treatment and a bed..

[EMTuKnowMe]

Originally Posted by taximedic234

There will also have to be increased communications between the cath labs and medcom.. The cath lab at WUH works on an "On Call" basis on the weekends and as mentioned it does the patient no good to be divereted to a cath lab if there is no one there to man it or they are all in use...

so, how long does it take for the cath lab that is "on call" to assemble and ready themselves to receive a patient?

other than the weekends, is the WUH cath lab ready to receive patients 24hrs/day?

[Dygear]

Originally Posted by taximedic234

That should be food for thought for all EMS agencies in the eastern part of nassau. THis should be voiced to remsco before the protocol is in place. and also EMS agencies should come up with a plan for their bus going from say Massapequa to Winthrop or South. or for Plainview jumping on the parkway to N. Shore.. It will be tying up your bus for a bit longer. It also means we have to lobby the hospitals to expidite triage and those patients with legit STEMI need IMMEDIATE treatment and a bed..

It should be noted what hospitals in Suffolk are STEMI capable hospitals.

Suffolk County Hospitals

1. (525) ‡Brookhaven Memorial Hospital Medical Center Inc (Patchogue)
   
   • Area Trauma Center
     
   • Stroke Center
     
2. (514) Eastern Long Island Hospital (Greenport)
   
3. (515) ‡Good Samaritan Hospital Medical Center (West Islip)
   
   • Area Trauma Center
     
   • Level 3 Perinatal Center
     
   • SAFE Center
     
   • Stroke Center
     
   • Cardiac Catheterization (Adult)
     
4. (516) ‡Huntington Hospital (Huntington)
   
   • Area Trauma Center
     
   • Level 2 Perinatal Center
     
   • Stroke Center
     
   • Cardiac Catheterization (Adult)
     
5. (517) John T Mather Memorial Hospital of Port Jefferson New York Inc (Port Jefferson)
   
   • SAFE Center
     
   • Stroke Center
     
6. (613) Peconic Bay Medical Center (Riverhead)
   
   • Level 1 Perinatal Center
     
   • SAFE Center
     
   • Stroke Center
     
7. (520) Southampton Hospital (Southampton)
   
   • Level 1 Perinatal Center
     
   • Stroke Center
     
8. (521) ‡Southside Hospital (Bay Shore)
   
   • Area Trauma Center
     
   • Level 2 Perinatal Center
     
   • Stroke Center
     
   • Cardiac Catheterization (Adult)
     
9. (523) St Catherine of Siena Hospital (Smithtown)
   
   • Level 2 Perinatal Center
     
   • Stroke Center
     
   • Cardiac Catheterization (Adult)
     
10. (528) St Charles Hospital (Port Jefferson)
    
    • Level 2 Perinatal Center
      
    • Stroke Center
      
11. (527) ‡University Hospital (Stony Brook)
    
    • AIDS Center
      
    • Burn Center
      
    • Regional Perinatal Center
      
    • Regional Trauma Center
      
    • Stroke Center
      
    • Cardiac Catheterization (Adult)
      
    • Cardiac Catheterization (Pediatric)
      

*(525) ‡Brookhaven Memorial Hospital Medical
(512) Brunswick Hospital
*(514) Eastern Long Island Hospital
*(515) ‡Good Samaritan Hospital
*(516) ‡Huntington Hospital
*(517) J. T. Mather Memorial Hospital - Port Jefferson
*(613) Peconic Bay Medical Center
*(523) St. Catherine of Siena Hospital
*(528) St. Charles Hospital
*(520) Southampton Haspital
*(521) ‡Southside Hospital
*(527) ‡University Hospital Health Services - SUNY
(524) Veterans Administration Hospital

[Dygear]

Ok, just spoke with the Nassau County REMSCO's QA/QI Coordinator who states that NUMC never had a active cath lab, so there ya go.

[brandweer]

Originally Posted by MEDIC6958

legal no its the medical directors not trusting the cc to make the right call (not that theres anything wrong with cc's). I can teach any cc in 5 minutes to read 12 leads. And NYS has nothing to say about the scope of practice in nassau county the state sets guide lines (minimum requirements) which means if nassau wanted cc and medics to do serigical trachs they would. all it is a matter of seeing how ccs are able to read 12s. and its time for the professional volinteers to kick it up a notch and get it done.

Actually you are wrong... NYS does have educational standards and the remsco CANNOT authorize techs to operate outside of these parameters. It has nothing to do with how well you can teach CC's but 12 lead interpretaion is NOT in the CC's training and scope. We tried go around this but thats the way it is. And NO we cannot tall techs to do surgical trachs. EVERY concept for a protocol change must be reviewed against several parameters and the training/scope of practice issue is just one. After its been approved locally and it goes out for public comment (and just for the record, there are few to any comments EVER submitted - the rant doesnt count), it must go to the state level for review and approval, and one of the first things they look at is the training/scope.

[MEDIC6958]

Originally Posted by brandweer

Actually you are wrong... NYS does have educational standards and the remsco CANNOT authorize techs to operate outside of these parameters. It has nothing to do with how well you can teach CC's but 12 lead interpretaion is NOT in the CC's training and scope. We tried go around this but thats the way it is. And NO we cannot tall techs to do surgical trachs. EVERY concept for a protocol change must be reviewed against several parameters and the training/scope of practice issue is just one. After its been approved locally and it goes out for public comment (and just for the record, there are few to any comments EVER submitted - the rant doesnt count), it must go to the state level for review and approval, and one of the first things they look at is the training/scope.

Yes, NYS does has minimum educational standards for passing the NYS EMT-CC exam. BUT each county is responsable for writing thier own als protocols. If NYS wrote the als protocols then how are NYC and Suffolk remac allowing thier cc's to perform 12 leads? ...They can beacuse they write their own protocols...

[ResQ80]

Originally Posted by MEDIC6958

Yes, NYS does has minimum educational standards for passing the NYS EMT-CC exam. BUT each county is responsable for writing thier own als protocols. If NYS wrote the als protocols then how are NYC and Suffolk remac allowing thier cc's to perform 12 leads? ...They can beacuse they write their own protocols...

A way to get around EMT-CCs doing 12 leads is making a regionally approved class like Suffolk County does. Suffolk County offers this regionally approved class and puts out a list of 12 Lead qualified ALS providers. They also word their protocol to reflect this. The wording for the Suffolk County ALS Chest Pain Protocol explains the use of 12 Leads for CC's as:

Perform 12-Lead Electrocardiogram, if trained, equipped, and authorized to do so, and no exclusion criteria are present.

[zeroone]

Did i miss something? Where does it say a CC can't do a 12 lead? It says the STEMI interpretation is left up to the machine if its a CC, yet a medic can make the determination without the machine's interpretation.

I think with the "City" its just that, a city of a given population can operate at a different level. That is why they only recognize EMT's and EMT-P's

[Flyer0509]

Originally Posted by zeroone

Did i miss something? Where does it say a CC can't do a 12 lead? It says the STEMI interpretation is left up to the machine if its a CC, yet a medic can make the determination without the machine's interpretation.

That's what I see in the protocol. I also took the 12-lead class to try to get a better grasp of what I'm looking at. Just because the protocol says to be guided by the machine, it doesn't mean that we should fail to educate ourselves and continually improve!

[MEDIC6958]

Originally Posted by zeroone

Did i miss something? Where does it say a CC can't do a 12 lead? It says the STEMI interpretation is left up to the machine if its a CC, yet a medic can make the determination without the machine's interpretation.

I think with the "City" its just that, a city of a given population can operate at a different level. That is why they only recognize EMT's and EMT-P's

No you didn't that's my point cc's can do 12 lead.

[brandweer]

OK, once and for all, In NYS, the interpretation of 12 leads is NOT within the scope of an EMT-CC. This is the training curriculum. Some regions are doing it but this has to be approved by the State. We decided in Nassau to get the initial protocol approved and its still languishing at the state level BTW and then look at incorporating CC's down the road.

[MEDIC6958]

Originally Posted by brandweer

OK, once and for all, In NYS, the interpretation of 12 leads is NOT within the scope of an EMT-CC. This is the training curriculum. Some regions are doing it but this has to be approved by the State. We decided in Nassau to get the initial protocol approved and its still languishing at the state level BTW and then look at incorporating CC's down the road.

TELL THAT TO THE CC'S IN SUFFOLK THAT ARE READING 12 LEADS, FINDING THE AMI AND GET THE PT'S RIGHT TO THE CATH LABS. THEY ARE SAVING LIVES. SO TO SAY THAT IT IS NOT IN THE NYS SCOPE OF TRAINING IS WRONG. NYS DOESN'T WRITE ALS PROTOCOLS IT IS DONE AT THE LOCAL (COUNTY) LEVEL. PROTOCOLS NOT TRAINING.

[brandweer]

Well I see providing accurate information is wasting my time.... Any time you want the correct information, please attend a remsco or council meeting and we can discuss it. BUT, as I mentioned, 12 leads are not within the scope of practice and training for a CC. To add in something to a protocol that changes the scope of practice,it MUST be approved by several SEMSCO committees upstate. The Nassau STEMI protocol without a practice change has been upstate since July and doesnt look like any action until December. So , would you have rather us add in the scope/practice change (like Suffolk) and have it languish upstate until next year?? We had hoped to have the STEMI protocol out already..... You have to crawl before running....

[brandweer]

oh and BTW, although correct about the ALS protocols being regional, the State just won a battle to write the standards for ALS protocols so the statewide ALS protocols will probably be seen soon enough.

[emsteach124]

Originally Posted by brandweer

Well I see providing accurate information is wasting my time.... Any time you want the correct information, please attend a remsco or council meeting and we can discuss it. BUT, as I mentioned, 12 leads are not within the scope of practice and training for a CC. To add in something to a protocol that changes the scope of practice,it MUST be approved by several SEMSCO committees upstate. The Nassau STEMI protocol without a practice change has been upstate since July and doesnt look like any action until December. So , would you have rather us add in the scope/practice change (like Suffolk) and have it languish upstate until next year?? We had hoped to have the STEMI protocol out already..... You have to crawl before running....

Did ya ever feel like banging your head against a wall?

[MEDIC6958]

my point is that you can use a blanket statement like "NYS dosen't allow cc's to do 12-leads." because they allready do.

EMT-CC PROTOCOL 9
EFFECTIVE: February 1, 2000
REVISED: January, 2004
REVIEWED: February, 2007
CHEST PAIN / DISCOMFORT: SUSPECTED MYOCARDIAL ISCHEMIA
STANDING ORDERS

•

Aspirin 324 mg PO

•

Perform 12-Lead Electrocardiogram, if trained, equipped, and authorized to do so, and
no exclusion criteria are present.

•

IV of NS at KVO

MUST BE ESTABLISHED PRIOR TO GIVING NITROGLYCERIN
MAY OMIT IF BLS CRITERIA FOR ASSISTING WITH NTG ARE MET

IF HEART RATE IS BETWEEN 60-120

AND SYSTOLIC BP AT LEAST 120 AND

PATIENT HAS A HISTORY OF HEART DISEASE:

• Nitroglycerin 1/150 gr. SL.

maybe the reason for all the red tape upstate is that there is not a cath lab east of the meadowbrook parkway?

both our statements were right to a point.....and don't under stand what the state's problem is if cc's can already do 12's in suffolk. it just seems like the next logical step.

[Dygear]

NUMC should really step up and do this, if for no other reason then to fill the gap. New Island seems to want to do more. How about North Shore spend some money on their relationship and put a cath lab in there?

[Dygear]

I was at NUMC's STEMI lecture about 3 weeks ago now, and I had the chance to speak with the MD presiding over the CCU @ NUMC. He is a doctor from North Shore LIJ and he states that there are no current plans to bring a Interventional Cath Lab to NUMC.

It's sad really.