EMS 12-Leads: Early and Often

The 12 lead ECG to detect ST elevation MI’s (STEMI) is one of the most important things we do for our patients.  I didn’t grasp how important they are until I started working in a system that integrates them into a hospital heart alert program.  To answer the 12-lead non-believers at other organizations I worked with,  I wrote an article for EMS Magazine (now EMS World) five years ago.

In 2008, a group of medical directors known as the Eagles published a paper with a “number needed to treat” formula to show just how important STEMI alert programs are.  For every 15 STEMI patients who receive an prehospital ECG, aspirin, and have the hospital’s cath lab activated before the patient arrives, one stroke, second heart attack, or death is prevented.

Over at the First Responder Network, ECG guru Tom Bouthilet hosted the Code STEMI web series.  This features EMS and hospital best practices to get the most value from early STEMI detection.

At EMS 1, Tom also writes about the importance of a 12-lead with the first set of vitals.  He describes how a patient with a 99% occlusion of her right coronary artery’s  ST elevation normalized after being moved to the ambulance.  He goes on to describe what could have happened to the patient if the crew waited to do the ECG in the truck.

The importance of frequent ECG’s was described in the latest issue of Prehospital Emergency Care.   Toronto EMS’s  protocol is to do an ECG with the first set of vitals, another in the ambulance before transport, and one more before entering the hospital.  Over one year they examined 325 consecutive STEMIs, and only 275 (85%) were detected with the first ECG.  The rest would have been missed without serial ECG’s.  According to the Eagles paper, three patients were saved from death, stroke, or a second heart attack that year.

When and how often we do ECG’s is one little thing that makes a big difference for patients.  Do one in their house, even before taking their blood pressure.  Leave the cables hooked up and get  more in the ambulance, especially if the patient reports that their discomfort changes.  Lives, and quality of lives, can be saved with the push of a button.


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