Clinical Compliance of Paramedic Students Acquiring Prehospital 12-lead ECGs

Dean C. Meenach, RN, BSN, CEN, CCRN, CPEN, EMT-P; Thomas Dobrzynski, BS, NRP; Joanne Ruck, API, RN, BPS BN; Mark Cromer, MS, MBA, NRP; James D. Dinsch, MS, NREMT-P; Elizabeth C. Landry, BS, NREMTP; Alyssa R. Morris BS; Sara Richter, MS, EMT-B; Michael Bowen, NREMT-P; Jesse Mortenson, BA.

Introduction

Obtaining prehospital 12-lead ECGs on selected patients has been an AHA Class I recommendation since 20001. Emphasis of prehospital 12-lead ECG acquisition has been of increasing academic and clinical importance since the publication of the National EMS Education Standards2 and 2010 AHA Guidelines3 leading to prehospital 12-lead acquisition protocols worldwide. The purpose of the study is to evaluate if paramedic students acquire 12-lead ECGs as part of their differential diagnosis.

Hypothesis

Paramedic students acquire prehospital 12-lead ECGs on all adult patients meeting clinical criteria.

Methods

Data on prehospital 12-lead ECG acquisition from 2010-2012 for patients age ≥18 complaining of chest pain, dizziness, AMS, syncope, change in responsiveness, headache, blurred vision, malaise, abdominal pain, breathing problems, nausea/vomiting, or palpitations were abstracted from FISDAP®, an Internet-based administrative database, for students with “good” data and research consents. Patients classified as trauma, childbirth, allergic reactions, cardiac arrest, and death were excluded. Descriptive summaries were generated and differences by gender were analyzed by chi-square tests.

Results

Of the 89,507 patients meeting inclusion criteria, 33.2% received a 12-lead ECG. Percent of 12-lead ECG application differs by complaint and patient gender, see Table 1.

Table 1. Percent of Patients Receiving 12-Lead by Complaint
ComplaintnOverallFemaleMalep-value
Chest Pain22,34858.357.559.10.0145
Palpitations8261.057.165.00.4660
Altered Mental Status24,25726.026.425.60.1193
Abdominal Pain16,59024.523.226.6< 0.0001
Breathing Problem27,66239.437.641.6< 0.0001
Change in Responsiveness12,06636.334.438.4< 0.0001
Dizziness21,01636.834.839.3< 0.0001
Headache, Blurred Vision11,51131.129.832.90.0004
Malaise19239.645.829.70.0270
Nausea/Vomiting42139.743.134.30.0713
Weakness38,66333.131.734.7< 0.0001
Overall89,50733.231.934.8< 0.0001


Discussion

Prehospital 12-lead acquisition is an important component of differential diagnosis. Paramedic students demonstrate subclinical frequency regarding 12-lead ECGs for all identified complaints. Limitations include the self-reported nature of the data. It is important to note that the data does not account for potential limited access to 12-lead ECGs and preceptor bias. Further studies should focus on controlling for these limitations and identifying additional obstacles to obtaining 100% clinical compliance.

References

1Part 7: The era of reperfusion : Section 1: Acute coronary syndromes (acute myocardial infarction). (2000). Circulation, 102(Supplement 1), I-172-I-203. doi: 10.1161/01.CIR.102.suppl_1.I-172

2National Highway Traffic Safety Administration (2009). National emergency medical services education standards. Washington, DC: United States Department of Transportation.

3O'connor, R. E., Brady, W., Brooks, S. C., Diercks, D., Egan, J., Ghaemmaghami, C., ... Yannopoulos, D. (2010). Part 10: Acute coronary syndromes: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 122, S787-S817. doi: 10.1161/CIRCULATIONAHA.110.971028