The American Heart Association’s Mission: Lifeline (AHA ML) conducted a survey of the nation’s EMS systems.
Significant findings include:
- Only half of EMS systems have 12 lead ECG monitors on 75 percent or more of their vehicles.
- Of EMS systems with 12 lead ECGs, most lacked a standard method for EMS to communicate the results to the hospital. Currently, paramedics use one or more of the following methods: 1.) verbally reporting the computerized interpretation, 2.) verbally reporting their own interpretation of the ECG reading, or 3.) using an advanced technology like Bluetooth or mobile phone to transmit the ECG for physician interpretation.
- EMS field personnel remotely activate hospital catheterization labs only 40 percent of the time. This can significantly delay evaluation and treatment.
- Destination protocols are only used a third of the time to enable EMS to take STEMI patients directly to a hospital capable of providing primary PCI 24 hours a day, seven days a week. Instead, many EMS departments take patients to the closest hospital, which can cause significant delays to appropriate care.
- Only about 20 percent of hospitals are able to perform primary PCI 24 hours a day, seven days a week.
Robert E. O’Connor MD, chair of the AHA ML ECC task force said:
“We were encouraged that more EMS systems than anticipated had vehicles equipped with 12 lead ECGs, devices that diagnose STEMI and other heart attacks. However, we found the need for better systems to allow EMS to transmit data from ECGs and activate the cath lab on the way to the hospital and for policies allowing them to take patients to the facility able to provide appropriate care, whether it’s the closest facility or not.”
Other findings include:
- More paramedics should receive training on interpreting 12 lead ECGs.
- Funding is needed for additional 12 lead ECG devices and training.
- Information sharing between EMS and hospitals is poor, so it’s difficult to track the quality of care a patient receives as they move from EMS to hospital-based care. Confidentiality requirements are hindering the process.
One gripe that I’m hearing already is that the AHA ML survey did not take into account tiered systems like King County Medic One. Apparently a minority of ambulances in that system are ALS (with 12 lead monitors) and yet it’s one of the best EMS systems in the country.
That’s a fair point! It doesn’t matter whether or not every ambulance in the system has a 12 lead monitor. What matters is that ACS patients get an ambulance with a 12 lead monitor.