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Related Experiment Videos

Recognition of ST elevation by paramedics.

M Whitbread1, V Leah, T Bell

  • 1Resuscitation Service, Royal Hospital NHS Trust, London, UK.

Emergency Medicine Journal : EMJ
|January 5, 2002
PubMed
Summary

UK paramedics can accurately recognize ST elevation using a 12-lead electrocardiogram (ECG). This finding suggests prehospital ECG interpretation by paramedics may not require radio transmission to alert hospitals.

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Area of Science:

  • Emergency Medicine
  • Cardiology
  • Paramedic Practice

Background:

  • ST-segment elevation myocardial infarction (STEMI) requires rapid diagnosis and treatment.
  • Prehospital electrocardiograms (ECGs) are crucial for timely STEMI identification.
  • The diagnostic capabilities of paramedics in interpreting 12-lead ECGs in a prehospital setting require definition.

Purpose of the Study:

  • To evaluate the ability of United Kingdom paramedics to accurately recognize ST-segment elevation on prehospital 12-lead ECGs.
  • To compare paramedic ECG interpretation accuracy against a criterion standard.

Main Methods:

  • Seven paramedics' diagnostic abilities were assessed 12 months post-training.
  • A two-day training course on 12-lead ECG interpretation was provided.
  • Cardiologist interpretation of 12-lead ECGs served as the criterion standard.
  • Paramedic and A&E SHO diagnoses were compared for accuracy, sensitivity, specificity, PPV, and NPV.

Main Results:

  • Paramedics achieved a median accuracy of 0.95 (95% CI 0.88–0.98).
  • Sensitivity was 0.97 (95% CI 0.94–0.99) and specificity was 0.91 (95% CI 0.53–1.0).
  • Positive Predictive Value (PPV) was 0.99 (95% CI 0.92–1.0) and Negative Predictive Value (NPV) was 0.77 (95% CI 0.62–0.92).
  • Performance was not significantly different from experienced A&E SHOs.

Conclusions:

  • UK paramedics demonstrate proficiency in recognizing ST elevation using 12-lead ECGs.
  • Prehospital interpretation of 12-lead ECGs by paramedics is feasible and accurate.
  • Radio transmission of ECGs may not be essential for pre-alerting hospitals.

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