I have been doing prehospital 12 lead ECG's for 14 years on ambulances. I
have seen the development of these units over the years and realise that
their full potential is not being realised.
If a cardiologist has enough power to influence the ambulance crews and the
recieving hospital then much can be achieved. Prehospital 12 leads do not
work if the results are ignored by the receiving hospital.

Where call to hospital (not leaving scene to hospital) times are about 30
minutes then 12 leads have a very important role to play in AMI care. This
accounts for the majority of calls encountered (10 mintues to scene, 10
minutes on scene and 10 minutes transport time is minimalistic figure). To
pre-alert a hospital for an incoming AMI which has been confirmed by a 12
lead ECG has been proved to reduce door to needle times. I have listed a few
of the studies where this has been demonstrated.[1-14]

Although the 12 lead computer diagnostic interpretation can at times give
incorrect readings,[15] the Dutch experience which relied on this system or
telephone transmission to a cardiologist in CCU proved to be safe.[16] This
resulted in a 1% false positive diagnosis from almost 2000 patients.[15] 12
lead ECGs can be acquired and successfully transmitted in approximately 70%
of patients with chest pains. This will increase on scene times by about 3.9
minutes.[17] In one trial over 75% of patients who were given thrombolysis
had cardiographic changes.[18] This represents the majority of patients
presenting with symptoms of a myocardial infarction.

12 lead ECGs are only a waste of time if the receiving hospital doesn't take
them seriously

Mike Bjarkoy
Paramedic
Sussex

1. Weaver D, Cerqueira M, Hallstrom AP, Litwin PE, Martin JS, Kudenchuk PJ
et al. Prehospital initiated vs. hospital initiated thrombolytic therapy:
the myocardial infarction triage intervention trial. JAMA 1993; 270: 1211-16
2. Aufderheide TP, Hendley GE, Woo J, et al: A prospective evaluation of
prehospital 12-lead ECG application in chest pain patients. J
Electrocardiol1992; 24(Suppl): S8-S13
3. Karagounis L, Ipsen SK, Jessop MR, Gilmore KM, Valenti DA, Clawson JJ et
al. Impact of field transmitted electrocardiography on time to in-hospital
thrombolytic therapy in acute myocardial infarction. Am J Cardiol. 1990; 66:
786-791
4. Foster DB, Dufendach JH, Barkdoll CM, et al: Prehospital recognition of
AMI using independent nurse/paramedic 12-lead ECG evaluation: Impact on
in-hospital times to thrombolysis in a rural community hospital. Am J Emerg
Med1994; 12: 25-31
5. Kereiakes DJ, Weaver WD, Anderson JL, Feldman T, Gibler B, Auferheide T
et al. Time delays in the diagnosis and treatment of acute myocardial
infarction: a tale of 8 cities. Am Heart J 1990; 120(4): 773-780
6. Kereiakes DJ, Gilber WB, Martin LH, Pieper KS, Anderson LC and the
Cincinnati Heart Project Group. Relative importance of emergency medical
system transport and the prehospital electrocardiogram on reducing hospital
time delay to therapy for acute myocardial infarction: a preliminary report
from the Cincinnati Heart Project. Am Heart J. 1992;123: 835-840
7. Aufderheide TP, Hendley GE, Thakur RK, Mateer JR, Stueven HA, Olson DW,
et al. The diagnostic impact of prehospital 12 lead electrocardiography.
Ann Emerg Med 1990; 19: 1280-1287
8. Aufderheide TP, Keelan MH, Hendley GE, et al: Milwaukee Prehospital Chest
Pain Project. Phase I: Feasibility and accuracy of prehospital thrombolytic
candidate selection. Am J Cardiol 1992; 69: 991-996
9. Aufderheide TP, Haselow WC, Hendley GE, et al: Feasibility of prehospital
rt-PA therapy in chest pain patients. Ann Emerg Med 1992; 21: 379-383
10. O'Rourke MF, Cook A, Carroll G, et al: Accuracy of a portable
interpretive ECG machine in diagnosis of acute evolving myocardial
infarction. Aust N Z J Med 1992; 22: 9-13
11. Grim P, Feldman T, Martin M, et al: Cellular telephone transmission of
12-lead electrocardiograms from ambulance to hospital. Am J Cardiol 1987;
60: 715-720
12. Weaver WD, Eisenberg MS, Martin JS, et al: Myocardial Infarction Triage
and Intervention Project: Phase I: Patient characteristics and feasibility
of prehospital initiation of thrombolytic therapy. J Am Coll Cardiol 1990;
15: 925-931
13. Fine DG, Weiss AT, Sapoznikov D, et al: Importance of early initiation
of intravenous streptokinase therapy for acute myocardial infarction. Am J
Cardiol 1986; 58: 411-417
14. Millar-Craig MW, Joy AV, Adamowicz M, Furber R, Thomas, B. Reduction in
treatment delay by paramedic ECG diagnosis of myocardial infarction with
direct CCU admission. Heart 1997; 78(5): 456-461
15. Grijseels EWM, Bouten MJM, Lenderink T, Deckers JW Hoes AW, Hartman JAM
et al. Prehospital thrombolytic therapy with either Alteplase or
Streptokinase. Practical applications, complications and long term results
in 529 patients. Eur Heart J 1995; 16: 1833-1838
16. Bouten MJM, Lenderink T el al. Prehospital thrombolysis wit Alteplase
(rt-PA) in acute myocardial infarction. Eur Heart J 1992; 13: 925-31
17. National Heart Attack Alert Program Working Group.  An Evaluation of
Technologies for Identifying Acute Cardiac Ischaemia in the Emergency
Department NIH Publication 1997: Jan
18. The GUSTO Investigators. An international randomised trial comparing
four thrombolytic strategies for acute myocardial infarction. N Engl J Med
1993; 329: 673-682


-----Original Message-----
From: [log in to unmask]
[mailto:[log in to unmask]]On Behalf Of Adrian Kerner
Sent: 12 July 2000 22:00
To: [log in to unmask]
Subject: Pre-hospital ECGs


What is the feeling amongst the group, about pre-hospital ECGs?

Within the National Service Framework on 'heart attack & other acute
coronary syndromes', we are to improve our 'door to needle times' as well as
'call to needle'.

Could we maximise the time involved and perform pre-hospital ECGs?

What do the pre-hospital people feel?

Regards

Adrian Kerner
SpR
Leeds



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