Can Paramedics Read ST-segment Elevation Myocardial Infarction on Prehospital 12-Lead Electrocardiograms?

Abstract

Paramedics in an urban/suburban EMS system can diagnose STEMI and identify appropriate cardiac catheterization laboratory activations with a high degree of accuracy, and an acceptable false-positive rate, when tested using paper-based scenarios.

Part 10: Acute Coronary Syndromes

“…Prehospital personnel can accurately identify ST-segment elevation from the 12-lead ECG. 47,50,[61][62][63][64][65][66][67][68][69][70][71][72][73][74] If providers are not trained to interperet the 12-lead ECG, field transmission of the ECG or a computer report to the receiving hospital is recommended (Class I, LOE B).…”

2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction

“…Although "false positives" are a concern when EMS personnel and/or emergency physicians are allowed to activate the cardiac catheterization laboratory, the rate of false activations is relatively low (approximately 15%) and is more than balanced by earlier treatment times for the majority of patients for whom notification is appropriate. [108][109][110][111][112][113][114] The concept of what constitutes false activation is evolving. 115,116 For patients who arrive at or are transported by EMS to a non-PCI-capable hospital, a decision about whether to transfer immediately to a PCIcapable hospital or to administer fibrinolytic therapy must be made.…”

Mortality and ST resolution in patients admitted with STEMI: the MOMI survey of emergency service experience in a complex urban area

“…This is consistent with the literature, which has shown that prehospital 12-lead ECG reduces door-to-balloon time by 10−55 minutes 19−24 and mortality by 7%; 24 it also suggests that prehospital ECG may either be transmitted for interpretation by hospital staff or can be interpreted locally by paramedics who then communicate their diagnosis to the hospital, with an acceptable false-positive diagnosis rate. 22,23,25,26 We speculate that the beneficial effects of recording and transmitting a 12-lead ECG in the prehospital phase of STEMI may not be restricted to patients managed with PCI; they may extend also to patients treated with thrombolysis by allowing prehospital administration and by reducing the in-hospital delay.…”