False Activation Rates by EMS and the ER Doctors on STEMI Patients - Research Paper Example

False Activation Rates by EMS (Paramedics) and the ER Doctors on STEMI Patients INTRODUCTION STEMI, which is acknowledged as ‘ST Segment Elevation Myocardial Infarction’ is a type of cardiac arrest, which experiences by the patients due to the blockage taking place within the arteries. STEMI is categorized as one of the severe categories of cardiac arrest and thus the patients are needed to be provided with ‘Emergency Medical Service (EMS)’ immediately from recovering the same. In this context, the Reperfusion therapy appears to be highly effective towards eliminating the blood clots within the arteries and restoring the normal flow of blood within the heart. In cases, when a patient experiences STEMI, it is the duty of the paramedics to detect the anomaly within the heart through the use of 12-lead electrocardiogram technique. Notably, the patients having STEMI gets examined in the ‘Cardiac Catheterization Laboratory (Cath Lab)’ setup within diverse medical facilities. However, within multiple medical facilities, the precision factor within the Cath Lab is not attained till date and as a result of which multiple cases of false activations regarding STEMI detection in patients have been addressed within the previous few years (National Center for Biotechnology Information, “Early cardiac catheterization laboratory activation by paramedics for patients with ST-segment elevation myocardial infarction on prehospital 12-lead electrocardiograms”). With this concern, the research paper will mainly focused on evaluating and understanding the trends as well as rates of false activations in relation to STEMI depending on which, effective strategies will be formulated as how to reverse the rise in the rates of such false activations. In addition, an assessment will also be conducted on the Emergency Room (ER) doctors and the EMS determining who should be held liable for the rising rates of such issue. Apart from these, the research paper will also focus towards elaborating the cases wherein the doctors have failed in detecting and activating the STEMI patients. Finally, a comparison will be made in the research paper regarding the data provided in opposition to national trends, elaborating the strategies that can be used in enhancing the provided data. REVIEW ON RATES OF FALSE ACTIVATIONS, TRENDS AND STRATEGIES TO CONTROL OR REVERSE THE INCREASE IN FALSE STEMI ACTIVATIONS Emergency services such as Reperfusion therapy is a high cost treatment against STEMI patients, which also results in multiple negative side-effects if practiced on the wrong patients. As a result, the EMS and the ER doctors remain highly cautious in terms of identifying the appropriate symptoms before declaring a patient to be suffering from STEMI. It can be apparently observed that rate of positive false activations in relation to STEMI detection has gradually increased over the previous few years. For instance, an increase in the false activation rate has been observed from being 15 % in 2007 to 40 % in 2011(Barnes, Katz, Desmond, Kronick, Beach, Chetcuti, Bates, and Gurm, 2013). In terms of activation count, the false count in this context ranged from 96 during the period 2007 to approximately 190 by the end of the year 2011. By taking into concern these data, the necessity of coming up with an effective STEMI detection technique can be felt. Moreover, it can also be ascertained that the drop in the timing factor of primary PCI, which is supposed to be provided to the patients suffering from STEMI, ranged from 67 minutes during the year 2007 to about 55 minutes by the year 2011(Stuart, 2013). Concerning the above discussed facts, utmost focus has been laid on one particular crucial factor concerning the misuse of medical resources and excessive mental stress on the EMS teams within the medical facilities as a result of false activations. It is worth mentioning that through conducting a thorough research in order to recognize the undermined factors, certain traces can be found regarding the faults of the EMS and the emergency departments of ER in terms of appropriately identifying the patients those are subjected to STEMI. Thus, the doctors of emergency rooms cannot be held responsible for this careless conduct. Additionally, lack of integrating modern equipments such as electrocardiograph devices and the biomarkers among others would generally add up towards raising the chances of inappropriate STEMI identification and false activations of Cath Labs (National Center for Biotechnology Informationb, “Prevalence and factors associated with false-positive ST-segment elevation myocardial infarction diagnoses at primary percutaneous coronary intervention–capable centers: a report from the Activate-SF registry.”). Specially mentioning the study of Busko (2012) highlighted the advantages of utilizing automated ECG diagnosis equipment in comparison with that of the traditional ECG machines. In the study, a comprehensive description regarding the decrease in the count of false activations of STEMI patients when diagnosed with the automated ECG equipment has been depicted. Apart from this, the other necessary parameters like ‘body mass index (BMI)’ through which the chances of occurrences of cardiac arrest are easily predicted can also be regarded as quite significant to control as well as reverse the augmentation in false STEMI activations (Fotopoulos, “Rate of False-Positive STEMI Diagnoses”). In relation to the above discussed facts, Maxwell (2012) emphasized majorly on the statements made by multiple doctors regarding their strategy of implantation the echocardiograms technique on the patient by ED department so as to make sure that the patients are positively subjected to STEMI (Cardiovascular Research Foundation, “Several Factors Behind False-Positive STEMI Activations”). CONSEQUENCES REGARDING FAILURE OF EMS AND ED IN IDENTIFYING STEMI AND ACTIVATING STEMI SYSTEMS Based on the above discussed facts, it can be affirmed that since the intensity of STEMI depends on the location of the clot, the negative implications of the patients lay in detecting their respective anomalies within stimulated time period. In precise, it can be affirmed that the failure of EMS and ED in the circumstance of identifying STEMI and most vitally activating STEMI systems can make the patients to experience critical health issues that might often lead towards death. Moreover, failure to detect STEMI and activate STEMI systems, the risk of life of the patients may also get augmented at large (Cygnus Business Mediab, “Debate: Direct Cath Lab Activation by Paramedics”). DATA COMPARISON By taking into concern the provided data against national trends, a vast gap can be seen within the rates of false activation. For instance, the rate of false activation related to STEMI has increased from 15% in 2007 to about 40% in 2011. Whereas, the data provided clearly states regarding the rise in the rate of false activation related to STEMI as 17% in 2011. Additionally, the provided data clearly separates the percentage increase in the rates both in the case of EMS and ED, whereas, the national data only describes about the percentage rise. Most importantly, the strategies including direct feedback to each individual provider after each case within 24 hours, 12 lead EKG interpretation education and STEMI criteria review may also appear appropriate in terms of increasing the precision factor towards detecting STEMI and activating Cath labs. In addition, laying focus on the BMI index of the patients and use of advanced biomarkers might also prove effective in enhancing the data provided. CONCLUSION From the above analysis and discussion, it can be ascertained that since STEMI is considered to be a severe form of cardiac arrest, thus appropriate measure are required to be followed in terms of identifying the subjection of the patients to this health anomaly. Moreover, since multiple cases have arouse regarding the false activation of Cath labs that can be duly considered as a result of inappropriate detection of STEMI, thus the necessity of exact identification of the anomaly is necessary through which the misuse of the medical resources can be brought down to minimum level. This will also help in terms of bringing down the cost factor associated with the medical facilities. Thus, from the overall understanding, it can be concluded that through the practice of appropriate STEMI detection techniques, the risk and stress factors imposed on both the patients and the EMS teams can be reduced by a certain degree. Works Cited Barnes, Geoffrey D., Alexander Katz, Jeffrey S. Desmond, Steven L. Kronick, Jamie Beach, Stanley J. Chetcuti, Eric R. Bates, and Hitinder S. Gurm. “False Activation of the Cardiac Catheterization Laboratory for Primary PCI.” 2013. Web. 08 Aug. 2014. “Debate: Direct Cath Lab Activation by Paramedics.” Cygnus Business Media. 2009. Web. 08 Aug. 2014. “Debate: Direct Cath Lab Activation by Paramedics.” Cygnus Business Mediab. 2012. Web. 08 Aug. 2014. Fotopoulos, Eileen Koutnik “Rate of False-Positive STEMI Diagnoses.” 2012. Web. 08 Aug. 2014. “Early Cardiac Catheterization Laboratory Activation by Paramedics for Patients with ST-Segment Elevation Myocardial Infarction on Prehospital 12-Lead Electrocardiograms.” National Center for Biotechnology Information. 2010. Web. 08 Aug. 2014. “Prevalence And Factors Associated With False-Positive ST-Segment Elevation Myocardial Infarction Diagnoses At Primary Percutaneous Coronary Intervention–Capable Centers: A Report From The Activate-SF Registry.” National Center for Biotechnology Informationb. 2012. Web. 08 Aug. 2014. Stuart, Candace. “Rates of False Activation of Cath Lab Rise As D2B Times Dip.” 2013. Web. 08 Aug. 2014. Read More