Acute ST-Elevation MI Declining in US

By Michelle Rizzo

NEW YORK (Reuters Health) Jul 24 - The incidence of acute ST-elevation myocardial infarction has steadily decreased in the US since 1996, regardless of gender or ethnicity, to the lowest rates in years.

The researchers retrospectively examined data from the Nationwide Inpatient Sample database from 1988 to 2004 to determine the trend in age-adjusted incidence of inpatient acute STEMI. They also assessed the incidence by gender and by various races. The findings are published in the July issue of the American Journal of Cardiology.

The database contained 1,352,574 patients, at least 40 years of age, who were diagnosed with STEMI between 1988 to 2004. The patients had a mean age of 66.06 years.

The age-adjusted STEMI rate was almost two times higher among men than among women (62.4% versus 37.6%, respectively). The age-adjusted rate for all acute STEMIs remained steady from 1988 to 1996 (108.32 per 100,000 in 1988; to 102.5 per 100,000 in 1996).

The age-adjusted incidence steadily decreased to half the incidence of the previous 8 years from 1996 onward (50.0 per 100,000 by 2004, p < 0.01).

This is good news. I was surprised by their findings. Health care in general has changed in the ten years I've been doing EMS. New and improved medications, new technologies, better informed patients, etc. Maybe one day they'll actually be able to prevent heart attacks all together. That's bad news for job security. :0)

Oklahoma Trooper Interferes With Patient Care and Assaults EMT

I was astounded to catch a report of this story on Fox News this evening. Let me set this up for you. The ambulance has a sick patient in the back that they are transporting without lights and without sirens to a local hospital.

The trooper in the video is attempting to respond to a separate emergency. The trooper approaches the ambulance at a high rate of speed with only his warning lights on and rides the bumper of the ambulance. This is equivalent to being on the bumper of a semi. The ambulance is box shaped and that is why every fire truck and ambulance says stay back 100 feet, because we can't see what's going on directly behind us.

The driver of the ambulance does not see or hear the trooper behind him, which apparently works to enrage this trooper. When the driver finally realizes the trooper is behind him, he pulls over. As the trooper passes he comments rudely on the radio' "try checking your rear views," or something to that effect, and the driver responds with a gesture of surprise, which the trooper would later claim he thought was an obscene gesture.

The trooper then comes back and stops the ambulance. The paramedic, thinking that there must be some kind of medical emergency accounting for the erratic behavior and driving of the trooper, gets out and attempts to determine what the problem is and help. The paramedic explains that they have a patient and pleads with the trooper to follow them to the hospital and deal with the situation after patient care has been transferred. The trooper then tries to forcefully arrest the paramedic, who resists (as I believe he should have) because the patient is under his care. The trooper places the paramedic in a choke hold, which is against police procedure. The trooper eventually relents and the patient is transported.

Attorney Gary Jones, representing Trooper Martin, stated that Trooper Martin was within his legal authority to stop the ambulance because the ambulance was not running with its lights or sirens on. James also said the paramedic escalated the situation by challenging the trooper. While it is true that the Trooper was within his legal right to stop the ambulance, that does not excuse the fact that he did or the fact that he needlessly assaulted the paramedic and tried to force him to abandon his patient.

The trooper's only defense is that the paramedic made matters worse by getting out of the back of the ambulance. Points to ponder here...the treating paramedic is the one in charge of that ambulance. The responsibility for the patient's care and everything that happens in the course of that call falls squarely on the shoulders of that paramedic. This wasn't like a typical traffic stop where an officer would have to worry about a perp getting out of a vehicle that he was stopping. I maintain, that this course of defense for the officer is absolutely absurd.

This whole matter was instigated by an out of control police officer. I encourage you to read the paramedic's written report of the incident. I hope that this trooper loses his job. The unprofessional conduct of this officer, coupled with his inability to maintain control, his flagrant disregard for the well-being of the patient being cared for, his reckless driving, and his apparent lack of knowledge of the law concerning Paramedic's in the line of duty make him a danger to the community at large and a disgrace to his community and profession.

I'm happy to say, that in general, emergency public agencies enjoy a high level of professional courtesy both on and off duty. Very rarely does a police officer act against an EMT or Firefighter, very much like they provide the same courtesy to fellow police officers. Stories like this paint a mostly false picture of public service cooperation that distorts the professions we chose to serve in.

In the end, the D.A. opted not to prosecute either side of this scuffle. The D.A. would have been in a worse case scenario. While the officer was with in his right to stop the ambulance, he also committed a felony when he assaulted the paramedic and interfered with the medical treatment of his patient.

For more detail on this story visit KOTV's website.

EMS Statistics From Inauguration

Crews -- that include six EMS task forces -- handled 1,148 responses between 4 a.m. and 4 p.m. Personnel in first aid stations on the Mall treated 490 people, and transported 31.

Officials in the command operations center -- located in Engine 2 -- said there was a crush of calls between 4 and 5 a.m. that stretched local resources because mutual aid crews had not arrived.

By 3 a.m., crews were overwhelmed by the masses who were braving the frigid temperatures for a spot. Although there were 40 warming tents set up, and several buildings were open, many suffering from exposure didn't take advantage of the care.

By 8:25 a.m., officials said there were more than 400,000 on the Mall. The requests for EMS were continuous. Fire officials said that between the hours of 4 a.m. and 10 a.m., they responded to 262 calls. Those included everything from falls to people with diabetic emergencies, and exposure issues.

EMS crews were busy at the L'Enfant Plaza Metro station when several people required medical assistance after escalators broke down under the weight of the crowd. In addition to several suffering chest pains and difficulty breathing after climbing the stairs, others were complaining of heat issues, officials said.

A woman fell onto a Metro track near Gallery Place, but was not seriously injured.

There were roughly 200 ambulances stationed in the city, with 80 from D.C. Fire. FEMA supplied nearly 100 ambulances.

At Engine 2, second floor offices were equipped with flat screen televisions which monitored several different news channels. There were also maps stretched across walls, white boards filled with important information, and cameras monitoring local roadways.

Ambulance crews from nearby jurisdictions were assigned a navigator who was helping guide them through the city.

Additional ambulance crews that were on standby were called into the city to assist. Schultz said it was fortunate that those units were at the ready.

"The mayor declaring a state of emergency was a brilliant move," he said, because it ensured that fire officials had the resources they needed. Sirens blared as units attempted to weave through crowds. People often ignored the emergency vehicles.

In the command center, officers were keeping tabs on resources, the crowd, traffic and requests for assistance.

Every two hours, all section chiefs gather in an office to report on what's happening. Schultz keeps the meetings short, telling the officers to relay only the pertinent information. Many were operating on little sleep.

Schultz said plans call for the center to stay open until at least 3 a.m. Wednesday.

Source