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Comment by JshWright | Hacker News Reader

Interesting... I would have assumed Germany would be a bit more advanced in prehospital care.

Here in the US (in a rural/suburban area outside a smallish city in upstate New York), the flow would look more like:

A paramedic recognizes a potential MI and takes a 12-lead EKG. If it is indeed a STEMI, then we'll call the ER and transmit the EKG and other vitals (via a cell modem embedded in the monitor). If the ER doc agrees with my diagnosis, then the cath lab is activated.

I'll have a couple large bore IVs in place before we arrive at the hospital, and when we get to the hospital, the patient stays right on our stretcher as we bypass the ER entirely at take them directly to cath.

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For an unstable patient, our process is much the same - the EMTs will put in the IVs, and we'll bypass the ER to proceed directly to the cath lab. For stable patients, the EMTs will prioritize getting them to the hospital as fast as possible and often won't have the time to get the IVs into place before they arrive. (This part of the county has a ridiculous density of hospitals, so the ambulance ride is frequently not even five minutes long, which doesn't give the EMTs that much time to work.)

We've found that things go little more smoothly if we do some of the prep in the ER, where there's a little more space for people to undress the patient etc. without worrying about bumping into the expense catheter equipment or compromising sterility, but even stable patients aren't supposed to spend more than five minutes there before being rushed to cath.

I do wish we had some way to directly transmit EKGs and vitals. American hospitals seem to have more money available for electronic equipment like that. (On the other hand, in Germany, the whole hospital stay including the catheter and a day in the ICU, probably won't cost you more than 10.000 Euro, and usually less than that.)

Is there any opportunity (or practice) of other conditions bypassing the ER? If that's the bottleneck, I hope it doesn't have to be life-or-death for someone to thing "We should re-engineer this process".

E.g. uncomplicated fractures getting brought to the fracture clinic?

The reason for bypassing the ER in this case is because every minute means more damage to the heart. A fracture is not especially time sensitive. Stabilize it in the ER, take some images, and refer them to an orthopedist in a day or two. There would be no significant change in patient outcome by shaving any time off that process.

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