Paramedic ability to recognize ST-segment elevation myocardial infarction on prehospital electrocardiograms

Area of Science:

• Emergency Medicine
• Cardiology
• Medical Diagnostics

Background:

• Paramedic identification of ST-segment elevation myocardial infarctions (STEMIs) can reduce treatment delays.
• While paramedics are trained in electrocardiogram (ECG) interpretation, their accuracy in identifying STEMIs is not well-established.

Purpose of the Study:

• To evaluate the accuracy of paramedics in recognizing STEMIs on ECGs.
• To assess paramedic performance when presented with STEMI mimics.

Main Methods:

• A descriptive cohort study involving a survey administered to 472 paramedics.
• The survey included questions on training, experience, and confidence, alongside 10 ECGs (3 STEMIs, 2 normal, 5 mimics).
• Calculated overall sensitivity, specificity, and proportion correct with 95% confidence intervals.

Main Results:

• Paramedic sensitivity for STEMI detection was 75% and specificity was 53%.
• Accuracy varied by STEMI type (inferior: 96%, anterior: 78%, lateral: 51%) and mimic recognition (LVH: 37%, LBBB: 39%, ventricular pacing: 53%).
• No correlation found between training, experience, or confidence and diagnostic accuracy.

Conclusions:

• Paramedics demonstrated limited accuracy in identifying STEMIs and interpreting ECG mimics.
• Sole reliance on paramedic ECG interpretation for cardiac catheterization lab activation is not advisable.
• Future research should focus on enhanced training programs with assessment, feedback, and repeat training for paramedics.