12-lead electrocardiograms during basic life support care

Prehospital 12-lead electrocardiograms (PTLs) decrease time to thrombolytics. Paramedics have performed them successfully for years, but emergency medical technicians (EMTs) have not typically performed them. To determine whether PTLs could be considered a basic life support (BLS) skill, the authors conducted a pilot study to determine whether scene times are lengthened when EMTs obtain PTLs, whether EMTs can appropriately select patients for PTLs, and what value physicians place on prehospital PTLs.

The authors prospectively evaluated PTL performance in four BLS agencies. EMTs provided standard cardiac care to patients on even days. On odd days, they additionally performed a PTL. Scene times of patients receiving a PTL (n=77) were compared with scene times of similar patients not receiving one (n=100).

EMTs attempted to perform 101 PTLs, of which 77 were eligible for inclusion. The mean scene time [95% confidence interval] of patients on even days (no 12-lead) was 11.9 [11.0, 12.8] minutes, compared with 16.9 [15.8, 18.0] minutes for patients who received a PTL. Scene times increased by 5.0 [3.6, 6.4] minutes when a PTL was added to the evaluation. Physician feedback was received on 63 of 77 PTLs. Receiving physicians agreed that 59 of 63 (93.6%) patients needed the PTL and found them moderately helpful (3.56 on a 1 to 5 scale).

When EMTs performed PTLs, scene times increased approximately 5 minutes. Most physicians agreed that the PTL was indicated. PTL acquisition by EMTs appears feasible with slightly lengthened scene times, but evaluation in other BLS agencies is necessary to validate this conclusion.