Pre-Hospital 12-Lead Electrocardiography Programs

Garvey, J. Lee; MacLeod, Bruce; Sopko, George; Hand, Mary M.

doi:10.1016/j.jacc.2005.08.072

Cited by 87 publications

(8 citation statements)

References 67 publications

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“…Current guidelines recommend establishing regional STEMI networks with a focus on quality and practice‐based improvement to reduce EMS contact‐to‐balloon times . Pre‐hospital ECGs are believed to reduce the time from first EMS contact to reperfusion , but the frequency with which pre‐hospital ECGs are obtained remains low due to a lack of organized networks, patient education, EMS training, and cost . Several studies examined the effect of pre‐hospital ECG on reperfusion time, and all showed lower mortality among patients in whom a pre‐hospital ECG was obtained .…”

Section: Discussionsupporting

confidence: 79%

Impact of pre‐hospital electrocardiograms on time to treatment and one year outcome in a rural regional ST‐segment elevation myocardial infarction network

Kahlon

Barn

Akram

et al. 2016

Cathet Cardio Intervent

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Section: Discussionsupporting

confidence: 79%

Impact of pre‐hospital electrocardiograms on time to treatment and one year outcome in a rural regional ST‐segment elevation myocardial infarction network

Kahlon

Barn

Akram

et al. 2016

Cathet Cardio Intervent

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“…2–5 Therefore, reducing delays in treatment of patients with ACS should reduce morbidity and mortality. 6–14 …”

Section: Introductionmentioning

confidence: 99%

Factors Associated With Longer Time to Treatment for Patients With Suspected Acute Coronary Syndromes

Sullivan

Beshansky

Ruthazer

et al. 2014

Circ: Cardiovascular Quality and Outcomes

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Background Rapid treatment of acute coronary syndromes (ACS) is important; causes of delay in emergency medical services (EMS) care of ACS are poorly understood. Methods and results Analysis of data from the IMMEDIATE randomized controlled trial of EMS treatment of people with symptoms suggesting ACS, using hierarchical multiple regression of elapsed time. Out-of-hospital electrocardiograms were performed on 54,230 adults calling 9-1-1; 871 had presumed ACS, 303 of whom had ST-segment elevation myocardial infarction and underwent percutaneous coronary intervention. Compared to their counterparts, women, participants with diabetes, and participants without prior cardiovascular disease waited longer to call 9-1-1(by 28, p <0.01; 10, p 0.03; and 6 minutes, p 0.02, respectively). EMS arrival to electrocardiogram was longer for women (1.5 minutes, p <0.01), older individuals (1.3 minutes, p <0.01), and those without a primary complaint of chest pain (3.5 minutes, p <0.01). On-scene times were longer for women (2 minutes, p < 0.01) and older individuals (2 minutes, p <0.01). Older individuals and participants presenting on weekends and nights had longer door-to-balloon times (by 10, 14 and 11 minutes respectively, p < 0.01). Women and older individuals had longer total times (medical contact to balloon inflation 16, p 0.01, and 9 minutes, p <0.01, respectively; symptom onset to balloon inflation 31.5 minutes for women, p 0.02). Conclusions We found delays throughout ACS care, resulting in substantial differences in total times for women and older individuals. These delays may impact outcomes; a comprehensive approach to reduce delay is needed.

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“… 1 Barriers to effective adoption of ECG by EMS include the cost and replacement of equipment, paramedic training, and ongoing competency assessment. 9 However, previous studies designed to identify reasons for failure to obtain an ECG by EMS have generally focused on individual cities/EMS agencies or utilized only registry data where EMS systems in rural and underserved areas are typically underrepresented.…”

Section: Introductionmentioning

confidence: 99%

Variation in the Use of 12‐Lead Electrocardiography for Patients With Chest Pain by Emergency Medical Services in North Carolina

Bush¹,

Glickman

Fernández

et al. 2013

JAHA

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BackgroundPrehospital 12‐lead electrocardiography (ECG) is critical to timely STEMI care although its use remains inconsistent. Previous studies to identify reasons for failure to obtain a prehospital ECG have generally only focused on individual emergency medical service (EMS) systems in urban areas. Our study objective was to identify patient, geographic, and EMS agency‐related factors associated with failure to perform a prehospital ECG across a statewide geography.Methods and ResultsWe analyzed data from the Prehospital Medical Information System (PreMIS) in North Carolina from January 2008 to November 2010 for patients >30 years of age who used EMS and had a prehospital chief complaint of chest pain. Among 3.1 million EMS encounters, 134 350 patients met study criteria. From 2008–2010, 82 311 (61%) persons with chest pain received a prehospital ECG; utilization increased from 55% in 2008 to 65% in 2010 (trend P<0.001). Utilization by health referral region ranged from 22.9% to 74.2% and was lowest in rural areas. Men were more likely than women to have an ECG performed (63.0% vs 61.3%, adjusted RR 1.02, 95% CI 1.01 to 1.04). The certification‐level of the EMS provider (paramedic vsbasic/intermediate) and system‐level ECG equipment availability were the strongest predictors of ECG utilization. Persons in an ambulance with a certified paramedic were significantly more likely to receive a prehospital ECG than nonparamedics (RR 2.15, 95% CI 1.55, 2.99).ConclusionsAcross a large geographic area prehospital ECG use increased significantly, although important quality improvement opportunities remain. Increasing ECG availability and improving EMS certification and training levels are needed to improve overall care and reduce rural‐urban treatment differences.

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Pre-Hospital 12-Lead Electrocardiography Programs

Cited by 87 publications

References 67 publications

Impact of pre‐hospital electrocardiograms on time to treatment and one year outcome in a rural regional ST‐segment elevation myocardial infarction network

Impact of pre‐hospital electrocardiograms on time to treatment and one year outcome in a rural regional ST‐segment elevation myocardial infarction network

Factors Associated With Longer Time to Treatment for Patients With Suspected Acute Coronary Syndromes

Variation in the Use of 12‐Lead Electrocardiography for Patients With Chest Pain by Emergency Medical Services in North Carolina

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