Ability of paramedics to treat patients with congestive heart failure via standing field treatment protocols.

The objective of the study was to determine if paramedics can accurately select the appropriate standing field treatment protocol (SFTP) in lieu of on-line medical direction (OLMD) for patients with congestive heart failure. A prospective case series over 18 months determined the sensitivity and positive predictive value (PPV) of paramedics' treatment of CHF patients using SFTPs. All patients who were treated under the "rales" protocol and transported to our base hospital were evaluated for appropriateness of field treatment with correlation to discharge diagnosis. During this same time interval all patients ultimately diagnosed with CHF and treated by paramedics under any SFTP were studied. A total of 104 patients met the inclusion criteria with 102 available for analysis. Of the 58 patients treated under the rales protocol 50 (86%) had an ED diagnosis of CHF and 8 (13%) had a primary respiratory diagnosis. The remaining 44 (43%) of the 102 patients studied were treated under an SFTP other than rales but had a discharge diagnosis of CHF. Overall sensitivity for paramedics' correctly identifying CHF was 53%. Their PPV was 86%. In this study paramedics correctly identified only about half of the dyspneic patients who proved to have CHF, but their assessment of CHF did have a higher positive predictive value when this diagnosis was made. Further training and quality improvement efforts need to be directed towards improving paramedic performance with this challenging group of patients, with consideration given to requiring OLMD for patients presenting with rales.