Paramedic Ability to Recognize STEMI on Prehospital ECGs

February 25, 2014

In this study, paramedics were given a survey of ECG print outs and asked to identify an ST segment elevation myocardial infarction (STEMI) out of 10 rhythm strips. Paramedics were able to correctly identify the inferior STEMI 96% of the time. They identified the lateral STEMI (51%) and the anterior STEMI (78%) at demonstrably lower frequencies. In this podcast, the speakers recognize the potential shortcomings of the study design: the ECG print outs utilized were markedly difficult to interpret, were borderline in terms of STEMI mimics, and were prone to under-evaluation due to lack of patient context. The conclusion drawn from this study states that “given the paramedics' low sensitivity and specificity, we cannot rely solely on their ECG interpretation to activate the cardiac catheterization laboratory,” but the speakers criticize this assertion given the study design and potential motivation.

Speakers: Alexander Trembley, NREMT-PPeter Tanghe, MDKeith Wesley, MD, FACEP

Original study: "Paramedic Ability to Recognize ST-segment Elevation Myocardial Infarction on Prehospital Electrocardiograms," by Francis Mencl, MD, MS; Scott Wilber, MD, MPH; Jennifer Frey, PhD; Jon Zalewski, NREMT-P, RN; Jarrad Francis Maiers, MD; Mary C. Bhalla, MD.