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Letters / Correspondance CJRM 1999;4(3):170 Please send us your comments and opinions. Letters to the editor should be addressed to: Canadian Journal of Rural Medicine, Box 1086, Shawville QC J0X 2Y0; cjrm@fox.nstn.ca, fax 819 647-2845 Chest pain guidelines Your article on chest pain guidelines was very practical. One of my colleagues suggested a useful addition, which would go near the beginning of the protocol: "If the patient collapses, nurse attaches leads and activates automated external defibrillator. If indicated, nurse defibrillates." While this would require many of our hospitals to purchase AEDs and educate staff in their use, it would save lives. It is ironic that patients developing ventricular fibrillation in many ambulances will be defibrillated by ambulance attendants, but not in some rural ERs, until a physician arrives.
Mike Cotterill, MD © 1999 Society of Rural Physicians of Canada Dr. Thompson replies The Rural and Small-Urban Committee of the Canadian Association of Emergency Physicians supports your suggestion. In its policy statement "Recommendations for the Management of Rural, Remote and Isolated Emergency Health Care Facilities in Canada," the CAEP had already recommended that electronic treatment of arrhythmias should be available at all levels of facility, depending on the availability of trained providers (see the "CAEP Library/Guidelines" section at www.caep.ca). This includes automatic or semiautomatic external defibrillators in rural hospitals. I agree that these devices could improve access to immediate defibrillation in that setting, and that nurses should be supported to provide that type of care. The wording you suggest seems very appropriate.
Jim Thompson MD © 1999 Society of Rural Physicians of Canada |