When a patient presents with ischemic chest pain, the 12-lead ECG is almost the first diagnostic test the patient has to undergo(Beebe & Myers, 2010).Every paramedic faces situations where he/she has to deal with such patients. If an accurate 12-lead ECG is obtained within 10 minutes of a ST segment elevated Myocardial infarction patient’s arrival in hospital, there is a greater chance of survival of the patient(Drew et al., 2004). 40% of patients with myocardial ischemia are initially cared for by Emergency Medical Technicians(EMTs) and transported to specialized STEMI centers by Emergency Medical Services(EMS)(Brooks, Allan, & Welsford, 2009). The education and training of EMTs in carefully positioning leads on patient bodies, to acquire quality ECGs is important so they can reliably interpret and communicate pre-hospital 12-lead ECGs to the specialized centers of care(Ting et al., 2008). The more pre-hospital 12-lead ECGs (P12 ECGs) EMTs are allowed to take, the more their skills of detection of STEMI are enhanced. Proper electrode placement is an art and skill acquired by experience. The EMT needs to be able to recognize the earliest ECG change of ST elevation in the ECGs to diagnose STEMI. If the ECGS are transmitted over cell phone to the specialty centers, the EMTs need to identify the appropriate ECG with the correct patient, in order to avoid errors of diagnosis and treatment. More research needs to be done on factors like the appropriate use of EMS systems by patients, the responsiveness of EMS teams, why moreSTEMI patients do not utilize EMS, the responsiveness of EMS teams, and the EMT scene times to acquire P12 ECGs. As considerable investment of time, money, equipment, training and resources are required to be invested in the installation of P12 ECGs in the EMS systems, real world case studies are important to assess the cost effectiveness and t benefits of such systems. P 12 ECGs with advance Emergency Department notification provides timely reperfusion therapy to the STEMI patients. The success of a pre-hospital 12-lead ECG program will require the integration of all private, for-profit and non-profit EMS systems under the oversight of one regulatory body. With focused efforts and dedication, the EMTs and the EMS can be optimized to provide the best care possible to STEMI patients, through the timely acquisition of pre-hospital 12-lead ECGs.
References
Beebe, R., & Myers, J. (2010). Professional Paramedic, Volume II: Medical Emergencies, Maternal Health & Pediatrics (p. 1024). Cengage Learning. Retrieved from http://books.google.com/books?id=Gglzm1nsRfYC&pgis=1
Brooks, S. C., Allan, K. S., & Welsford, M. (2009). S TATE OF THE A RT • À LA FINE POINTE Review Article Prehospital triage and direct transport of patients with ST-elevation myocardial infarction to primary percutaneous coronary intervention centres : a systematic review and meta-analysis, 11(5).
Drew, B. J., Califf, R. M., Funk, M., Kaufman, E. S., Krucoff, M. W., Laks, M. M., Van Hare, G. F. (2004). Practice standards for electrocardiographic monitoring in hospital settings: an American Heart Association scientific statement from the Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young: endorsed by the Inte. Circulation, 110(17), 2721–46. doi:10.1161/01.CIR.0000145144.56673.59
Ting, H. H., Krumholz, H. M., Bradley, E. H., Cone, D. C., Curtis, J. P., Drew, B. J., Schuur, J. D. (2008). Implementation and integration of prehospital ECGs into systems of care for acute coronary syndrome: a scientific statement from the American Heart Association Interdisciplinary Council on Quality of Care and Outcomes Research, Emergency Cardiovascular Ca. Circulation, 118(10), 1066–79. doi:10.1161/CIRCULATIONAHA.108.190402
