Prehospital 12 Lead ECG Supplement in JEMS Magazine – July 2006

It’s a little bit dated now, but the July 2006 Prehospital 12 Lead ECG Supplement in JEMS magazine makes some interesting points.

10 Reasons to Perform a Prehospital ECG

  1. Does not significantly delay transport.
  2. Takes only one or two minutes to perform.
  3. Quality is increasingly high.
  4. Allows early diagnosis of AMI.
  5. Can be used to identify patients for prehospital lytic therapy.
  6. Allows a pre-alert to the hospital for a STEMI patient.
  7. Gives the cath lab personnel time to prepare.
  8. Provides the ED with a ECG to compare to past ECGs and to the one performed on ED arrival.
  9. Improves patient outcomes.
  10. Makes EMS an integral part of the chest pain team.

I especially approve of the opening comments of the third article, Applying — Not Just Implementing — a 12 Lead Program by Teresa McCallion.

Determining the success of a 12-lead ECG program is easy. Does it lead to advance notification of the receiving facility, speed diagnosis and shorten the time to reperfusion? The bottom line: Does it reduce damage to the heart muscle and save lives?

Early identification of an ST-segment elevation myocardial infarction (STEMI) and the speedy activation of the hospital’s cath lab have been proven to dramatically reduce wait time for patients who need cardiac catheterization. However, despite compelling clinical studies, many 12-lead programs have floundered. The primary culprit is often a lack of cooperation between EMS and the medical community.

She goes on to say:

The problem is that many hospitals are reluctant to activate a catheterization team at a cost of thousands of dollars based on the recommendation of paramedics, even when a 12-lead ECG has been transmitted from the field.

What she doesn’t say is that many ED physicians still don’t have the authority to activate the cardiac cath lab! That’s been one of the major priorities of the D2B Alliance. Activating the cath lab based on the prehospital 12 lead ECG is necessarily a stepwise process.

Cardiologists need to start trusting emergency physicians, and emergency physicians need to start trusting paramedics. It’s human nature that people generally don’t like to give up control. That’s why evidence based medicine is so important.

Activating the cath lab based on the prehospital 12 lead ECG is an evidence based strategy that is underutilized.

There is no legitimate reason why the cath lab can’t be activated while the patient is still in the field if the chief complaint is chest discomfort, and a 12 lead ECG with good data quality is transmitted to the emergency physician showing acute STEMI.

I’m not saying paramedics are incapable of interpreting 12 lead ECGs. I’m saying that something is wrong if the emergency physician refuses to activate the cardiac cath lab even though he’s seeing the STEMI with his own eyes.

I said it before and I’ll say it again. Make sure the ECG is transmitted with excellent data quality. Don’t give them an excuse!

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