Seizures

• Requires Advanced Life Support only if the patient remains in status epilepticus (continuous seizure) that lasts longer than than 5 minutes. This type of seizure is unlikely to resolve on it's own. It is then considered a medical emergency. Also consider ALS if patient is having multiple seizures, if airway is compromised, or if shock or trauma is evident.
• It is common for persons who have had a seizure to have an altered level of consciousness and to be very tired.

Strokes

• Advanced Life Support need not be called for stroke patients if that is the only consideration. They can do nothing to alleviate the stroke symptoms. The sooner after onset of symptoms a patient arrives at the Emergency Room the better for the patient.

Altered Mental Status

• Is a good indicator that a blood glucose test should be administered.
• Is a possible reason for Advanced Life Support

Overdose or Poisoning

• Consider attaching the EKG. Some medications and poisons can cause heart arrhythmias.
• Consider checking the blood glucose. Some medications and poisons can cause blood sugar to raise or lower drastically.
• Is a possible reason for utilizing Medical Control or Advanced Life Support

STEMI

From: Laudon, Dennis A., M.D
Sent: Wednesday, April 05, 2017 7:43 AM
There continues to be a lot of confusion regarding 12 lead ECGs transmitted by BLS ambulance services to St. Mary's Hospital. There is no mechanism to review these transmitted ECGs in real time. The BLS protocol is:

1. If the ECG computer interpretation is “STEMI”, the ECC should be contacted and the STEMI Protocol activated. This will activate the cath lab at St. Marys. Also a mandatory component of the protocol is that an ALS intercept should be requested by the ambulance service if the patients ETA is greater than 15 minutes.
2. For all other ECG interpretations the patient needs to be transported to the nearest hospital. If the patient meets criteria for an ALS intercept or ambulance crew concern warrants, an ALS intercept should be requested.
3. PLEASE DO NOT TRANSMIT THE ECG AND ASK OR WAIT FOR AN INTERPRETATION OF THE ECG. There is no mechanism to review the ECG and reply to the ambulance service in a timely fashion. If patient condition warrants ASK FOR AN INTERCEPT.