Training Day: Mastering the 12-lead

Training Day: Mastering the 12-lead

Acquiring and interpreting a 12-lead ECG – from the standpoint of a paramedic – is certainly a high-frequency, and even the occasional high-acuity, event.

Even at the BLS/EMT level, acquiring a 12-lead ECG is becoming a common skill in many states.

So, how can we master this valuable, care-directing and diagnostic-quality skill? Practice, test and reference often.

Even at the BLS/EMT level, acquiring a 12-lead ECG is becoming a common skill in many states.  So, how can we master this valuable, care-directing and diagnostic-quality skill? Practice, test and reference often. (Photo/Wikimedia Commons)
Even at the BLS/EMT level, acquiring a 12-lead ECG is becoming a common skill in many states. So, how can we master this valuable, care-directing and diagnostic-quality skill? Practice, test and reference often. (Photo/Wikimedia Commons)

Name that ECG rhythm

Practice doesn’t always equate to perfection, but it does equate to quantity.

Any initial paramedic program should have a built-in, extensive, elaborate and comprehensive ECG rhythm and 12-lead (and even 15- and 18-lead) interpretation component throughout its course.

New paramedic students should get their eyes on, and interpret, hundreds of ECGs – and I mean hundreds!

It’s all about exposure and building a “pattern” to how you interpret your ECG. Creating a step-by-step process to how you tackle this data is imperative at an early stage in the game (and under the controlled environment of a classroom, too!).

Validate your strengths, identify your weaknesses

Testing doesn’t always need to have the punitive component that we associate with it; it can be a valuable evaluation or assessment tool. It can provide validation and help identify areas for improvement.

After learning a new fact, skill, procedure, protocol or calculation, the only way that we can validate that the student has actually retained the information is to test them. This may occur through formal evaluation or informal observation but, in any event, testing is a necessary component of learning.

Paper still has its place in the testing world (or “evaluation world” – if you prefer). New to the market, however, are great electronic options that can be utilized via phone apps, online learning management systems and even via internal agency programs.

The end result of any learning process is to strive toward mastery. ECG acquisition and interpretation shouldn’t be a novice-level skill for paramedic providers – we need to become masters at it! The only way that we can validate this is through testing.

Use a 12-lead reference

Amongst the many (or few) calls that you respond to each year are respiratory complaints, traumatic injuries, coughs and colds, strokes, lift assists and the occasional cardiac event. Having said that, paramedics aren’t cardiologists, but that doesn’t mean we shouldn’t be able to speak their language!

For the complex cases, the atypical presentations and the funky-looking rhythms that you come across, having access to some form of reference can be a very valuable tool.

Interpretation apps can help to pinpoint the nuances of Sgarbossa’s criteria. A reference card can help to identify Takotsubo cardiomyopathy. A chart can help break down the differences between ventricular tachycardia and SVT with aberrancy.

If you don’t commit this information into memory (and no one necessarily says that you should), then invest in a reference guide that can help you recall it in the middle of the night. We use references with pediatric medication doses, why not use them with complex ECG interpretation?

Pulsara selected as winner of the 2018 EMS World Innovation Award

Pulsara selected as winner of the 2018 EMS World Innovation Award

EMS World pegs Pulsara’s cutting edge communication solution as the winner at EMS World Expo in Nashville.

EMS1 image

BOZEMAN, Mont. — Pulsara has repeatedly been recognized as a leading innovator in mobile healthcare communications and has recently garnered the distinction of receiving the 2018 EMS World Innovation Award. Identified as a finalist earlier this fall, Pulsara received the winning news this month. With the addition of Consult, Transfer and Video capabilities, the company’s mission to unite caregivers by connecting healthcare teams continues to shine through in their product advancements.

The 2018 EMS World Innovation Award recognizes new products or those that have undergone significant modifications or upgrades launched after June 15, 2017. It highlights new technologies that are transforming prehospital care and operations.

“We are humbled by the recognition that Pulsara is positively impacting the EMS Community,” said Kris Kaull, Flight Paramedic and Chief Marketing Officer, “Pulsara is a tool for clinicians, by clinicians. We care deeply about simplifying the care providers’ tasks while simultaneously helping those clinicians achieve better patient outcomes.”

Pulsara is a mobile-first platform that enables clinicians to exchange patient-specific information through alerts, messaging, audio clips or video chat during a time-sensitive emergency, no matter the location or type of illness or injury. It is designed for secure, two-way, real-time communication allowing all caregivers to receive the same information simultaneously, including photos (e.g., driver’s license for pre-registration, medication lists), estimated time of arrival, and case summary.

Pulsara is the only solution that entire regions can use to build a communication network between prehospital, intrafacility and interfacility care teams. Recent research shows that Pulsara decreases treatment times by an average of 30%.

“Our healthcare system is highly fragmented.  Traditionally, communication solutions have been as well,” said James Woodson, Pulsara CEO and Founder.  “Sixty-three percent (63%) of time is wasted secondary to ineffective communication during inter-facility patient transfers.  Our new and enhanced inter-facility communication functionality is yet another way regions can leverage our regional communication network to reduce treatment delays and improve patient outcomes.”

Effective communication is a key ingredient to patient safety in any situation, emergency or otherwise. Pulsara’s award-winning platform was built to improve the lives of patients and caregivers through innovative communication.

About Pulsara
Pulsara provides a real-time communication network across an entire region. The Pulsara platform, built on the power of mobile technology, unites the right clinicians at the right time for the right patient — providing transparency and streamlined communication. Simply CREATE a dedicated patient channel. BUILD the team. And, COMMUNICATE using audio, video, instant messaging, data, images, and key benchmarks. Studies report an average decreased treatment time of nearly 30% when using Pulsara. Pulsara is the evidence-based standard of care. For more information, visit

Silent night: A paramedic Christmas story

Silent night: A paramedic Christmas story

This article, originally published Dec. 22, 2011, has been updated with current information

We cooed over Seth’s baby girl for nearly an hour in the NICU. Med Star called us twice on the radio, asking us when we’d be back in service.

“We’re out of service for OSHA cleanup,” I lied. “My rig is a mess. We’ll let you know when we’re ready to go.” I winked at Seth and his wife as he rocked his little girl.

EMS1 image

“We may get to bring her home tomorrow,” Seth whispered. “Some Christmas present, huh?” I nodded and look pointedly at the clock on the wall. “I know,” Seth said, sighing. “We gotta go.”

“Sorry, Melissa,” I apologized as he handed the baby over. “There are little old ladies out there who have fallen and can’t get up.” She said nothing, just smiled and hugged Seth with one arm.

Later that night, we got called to stand by while the local police dealt with a hostage situation. Seth parked the rig on a side street several blocks away, turned off the lights, and settled back into his seat. After a while, he turned to me and asked, “How long you been a medic, Kelly?”

“Ten years,” I sighed. “It feels like more. It seems like I’ve always been a paramedic.”

“What did you do before you got into this line of work?” Seth asked curiously.

“I was a professional retriever trainer, if you can believe that,” I laughed. “Some switch, huh?”

“I’ll say,” Seth chuckled. “What keeps you doing it?”

“The great pay and the chicks, of course,” I said, deadpan.

Seth just frowned. “Come on, man, I’m serious,” he said. “I mean, here we are sitting in the dark on Christmas Eve, waiting for some guy to either shoot someone or get shot by the cops. Today an alcoholic nearly puked blood on us. You deal with drunks and derelicts and drug users. You pull broken bodies out of wrecks. You do boring transfers, shuttling little old folks back and forth between the hospital and the nursing homes. How do you do it without getting burned out?”

“Why are you a cop?” I asked him. “You see most of the same things, and you just took an EMT class. Why do you do it?”

He paused, reflecting. “I guess I just want to help people. But I’ve only been a deputy for two years. I haven’t even taken my EMT exam yet. But you’ve been a medic for ten years. So stop avoiding the question.”

I stayed silent for a while, unsure how to answer.

Why do I do it? Not for the money, certainly. I make good money for a paramedic, but it’s hardly what I’d make as a nurse or physician’s assistant. I dropped out of college, and I keep finding excuses why I can’t go back. So why do I do it?

“I’ve been burned out,” I began, not sure of what I intended to say.”Maybe six years ago. The job just wasn’t fun anymore. I didn’t feel appreciated, I wasn’t getting paid much, and I didn’t feel as if I made a difference. I took some time off, and I got over it.”

“How?” he pressed, unsatisfied by my answer.

“I figured out that I don’t save lives,” I explained. “Sometimes I get lucky, and we resuscitate someone successfully. Mainly it’s luck and good timing. I came to realize that what we do isn’t lifesaving. My job isn’t about blood and guts. It’s about helping people just like you do as a deputy.

“Your job isn’t all car chases and armed standoffs. You may go your entire career and never fire your weapon. There’s more to it than the adrenaline rush.” I looked at Seth and saw that he still didn’t get it.

“Look, two weeks ago I delivered a baby in the middle of the ice storm. It wasn’t fun. The fun part was seeing the mother’s face after I handed her the kid.”

“Two days ago, I took an old lady to the clinic for wound care on her bedsores. They stank, Seth. She stank, and she knew it. But I cracked a joke or two, made fun of her nurses, and I made her laugh. I held her hand on the way to the clinic, and she smiled at me when I dropped her off.”

“I started an IV on a six-year-old kid yesterday, and he didn’t even cry. He was more scared of the needle than of his broken arm, but I talked him through the stick, and he figured out that the needle wasn’t so bad.”

“We picked up a combative Alzheimer’s patient this morning, and the nurses were sure we’d have to restrain her, that she’d fight us. We talked to her for a bit, and she went with us without a fuss. We earned her trust.”

“Today I got to teach you something. That’s why I do it, for stuff like that.”

“And what about the ones without happy endings?” Seth asked darkly. “What about the ones who you can’t do anything for — the ones who die?”

“Well, you remind yourself that it isn’t your disease,” I answered. “You do the best you can. And you don’t let the things you see harden your heart.”

“Base to all units, stand down,” the radio crackled. “Repeat, stand down. Suspect is in custody. Channel is cleared for nonemergency traffic.” Seth grunted in surprise and flipped on the headlights.

“But that stuff will just eat you up,” he protested as we drove back to our station.

“I didn’t say let it eat you up, Seth. I said don’t let it harden you. You know those big, tough paramedics who don’t let anything bother them? They never last, or they stick around but nobody wants to work with them. They never cry, but they forget how to smile, too.”

“Keep looking for the good stuff,” I advised. “You can always find something good, if you just take the time to look.”

Just then the radio crackled, and an anonymous voice floated over the airwaves.

“‘And lo, the angel of the Lord came upon them, and the glory of the Lord shone round about them, and they were sore afraid. And the angel said unto them, Fear not: for, behold, I bring you good tidings of great joy, which shall be to all people. For unto you is born this day in the city of David a Savior, which is Christ the Lord.’ Merry Christmas, everybody.”

The radio clicked again and again as units around the parish keyed their microphones in response. I looked at my watch. It was just past midnight.

The dispatcher transmitted a moment later, adding only a quiet “Amen.”

“See what I mean?” I smiled. “Merry Christmas, Seth.”

Reprinted from En Route: A Paramedic’s Stories of Life, Death and Everything In Between by Steven “Kelly” Grayson with permission.
Copyright @ 2016 by Kelly Grayson.
Available on Amazon as a Kindle ebook or paperback.

Dispatcher honored for giving CPR instructions during call

Dispatcher honored for giving CPR instructions during call

By EMS1 Staff

BELLEVUE, Neb. — A dispatcher was given an award for her efforts in helping a caller perform CPR on her unconscious husband.

KETV reported that Sarpy County dispatcher Katie Porter was honored with the Lifesaving Award for instructing a woman on how to perform CPR on her husband, whom she found on the floor of their kitchen after returning from a jog.

“She just found her husband. She was freaking out. As long as I can be calm, I can get her to be calm,” Porter said.

The woman said she took CPR classes 10 years ago, but was panicking, so she let Porter guide her through chest compressions for two and a half minutes.

“You have to go faster ma’am. You’re doing a good job,” Porter can be heard telling the woman on a recording of the call.

Porter said callers are often too scared to try and perform CPR on their own.

“I felt like she did such a good job that there was the possibility that he could survive,” she said.

First responders arrived in less than five minutes and took over CPR before shocking the man’s heart five times.

The man later learned he had a 90 percent blockage in his artery, and, after a surgery, his wife said he will make a complete recovery.

Medical Director Dr. Eric Arnest said Porter’s actions were crucial in helping the man survive.

“The dispatcher is the key link in that chain of survival. Every minute that passes, you’re decreasing your survival chance by about 10 percent,” he said.

Porter said she was happy to learn that the man was doing OK.

“When I found out, it’s like holy smokes! He’s living! He’s walking!” she said. “It’s nice to know that what I did actually helped someone.”


Sarpy County 911 dispatcher Katie Porter (center) received a Life Saving Award from Emergency Communications Director William Muldoon (left) and Medical Director Dr. Eric Ernest.

Posted by Sarpy County, Nebraska on Tuesday, November 27, 2018


4 questions to answer before purchasing a specialty EMS vehicle

4 questions to answer before purchasing a specialty EMS vehicle

From off-road search and rescue operations to  navigating a crowd during a sporting event, specialty vehicles help provide EMS services in challenging situations, in addition to providing protection during active threat and MCI responses. No two specialty vehicles are created the same, and they’re certainly not created like our street ambulances.

Purchasing a specialty vehicle for your EMS agency requires some unique specifications that your agency must consider, like, will the vehicle be used solely for point A (scene) to point B (transporting ambulance) purposes? Or, will it be capable of (and credentialed for) transporting patients to a hospital?

Aside from these initial considerations, here are four questions that you should ponder when you’re in the market for purchasing and designing a specialty vehicle for your EMS agency.

No two specialty vehicles are created the same, and they’re certainly not created like our street ambulances. (Photo/Wikimedia Commons)
No two specialty vehicles are created the same, and they’re certainly not created like our street ambulances. (Photo/Wikimedia Commons)

1. What will the specialty vehicle be used for today?

Your response here will answer the original intent behind the purchase of this vehicle. Is it for off-road patient access, or crowd maneuverability inside of a stadium complex?

What equipment will it need to carry? Custom cabinetry can be designed to fit scoop stretchers, splinting equipment, trauma supplies and even larger oxygen cylinders. Starting with the vehicle’s initial intent, moreover, will help you to fill in the blanks for all functional considerations.

2. Is it a new addition, or does it re-purpose an existing vehicle?

We’re pretty good in EMS and the fire service at re-purposing our existing equipment. An old ambulance becomes a rehab unit. The former collapse rescue trailer becomes the hazmat team’s new decon unit. The prior command SUV becomes an off-road “mini ambulance.”

If your new specialty vehicle will be re-purposing an existing vehicle, then integrate your design successes into your new vehicle specifications. Don’t re-invent the wheel; if it works, then bring it into the new vehicle’s design.

If you’re purchasing an entirely new to your agency vehicle, then ask around. Get the vendor’s advice, speak with prior clients and see what others have done that is similar to your agency’s intent. This might be your first, but it doesn’t mean it’s the first.

3. Can it go where you need it to go?

An ATV or UTV will travel differently than an SUV or a bus, for that matter. Make sure that you’re able to meet your original intent by ensuring your specialty vehicle can actually get to where you need it to go.

Trails require a compact design with all-terrain wheels, while heavy snow cover might require a track system instead of wheels.

If your vehicle is designed for potentially-hostile environments that require secure cover, then simply adding some roll bars and sheet metal to a van won’t cut it; you need a vehicle specifically designed for this environment.

4. What can it be used for in 5 years?

Let’s face it: EMS is a changing industry. Whenever we make a new vehicle purchase, we hope that we can get as many miles and years out of it as possible. It’s important to plan for the future.

Try to anticipate what your community or response needs might look like in the future and design a specialty vehicle that might be able to fill some of those gaps. If the original intent is to purchase a supervisor SUV, then plan for it to eventually transition into a special event response unit once you reach 100,000 miles.

If you’re buying a low-profile UTV to fit into a parking garage and maneuver through a stadium, then also consider its potential use on local trails or through a construction zone on a local highway.

Build for today, but prepare for tomorrow.

NAEMSP® 2019 Annual Meeting Will Reunite Governor with Lifesaving First Responders

NAEMSP® 2019 Annual Meeting Will Reunite Governor with Lifesaving First Responders

OVERLAND PARK, Kan. — The National Association of EMS Physicians (NAEMSP) has several inspiring and informative presentations lined up for its 2019 Annual Meeting, which will take place January 7-12 in Austin, Texas. The conference will reunite its keynote speaker, former Pennsylvania Governor Tom Ridge, with the first responders who resuscitated him after his cardiac arrest in November 2017.

The 2019 Annual Meeting is an important part of NAEMSP’s efforts to educate EMS personnel on the latest advances and best practices in out-of-hospital emergency care. Emergency medical care experts from across the United States will cover important issues such as:

  •          School Shootings & Pediatric Trauma
  •          Affirming EMS Care for Transgender and Gender Non-Conforming Patients
  •          Integration of Public Health in EMS
  •          Rural EMS: Community Physician Response

“The NAEMSP Annual Meeting brings together EMS professionals from different disciplines and backgrounds and provides them the best information available,” says Brent Myers, NAEMSP president. “Everyone in the EMS community should attend whether you are an EMS physician, EMS officer, EMS educator or EMS front line provider.”

EMS physicians and non-physician professionals are invited to the two-day preconference EMS Quality Improvement and Safety Workshop, which will kick off the second occurrence of a year-long online course. Other popular preconference workshops, including the NAEMSP® National EMS Medical Directors Course and Practicum®, Out-of-Hospital Critical Procedure Cadaver Lab and Operational Canine: Point of Injury Medical Care for EMS Medical Directors, will also return in 2019. Registration is available on the NAEMSP website.

NAEMSP is comprised of physicians and EMS professionals dedicated to providing leadership and fostering excellence in the subspecialty of EMS medicine and out-of-hospital care. NAEMSP is a leading healthcare advocate, most recently securing the passage of the Protecting Patient Access to Emergency Medications Act.

About the National Association of EMS Physicians (NAEMSP)
The National Association of EMS Physicians (NAEMSP) is an organization of physicians and other professionals partnering to provide leadership and foster excellence in the subspecialty of EMS medicine.