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Recognition of ST elevation by paramedics
  1. M Whitbread1,
  2. V Leah2,
  3. T Bell3,
  4. T J Coats3
  1. 1Resuscitation Service, Royal Hospitals NHS Trust, London, UK
  2. 2Resuscitation Service, Joyce Green Hospital, Dartford, UK
  3. 3Department of Accident and Emergency, St Bartholomew's and the Royal London School of Medicine, Queen Mary and Westfield College, London, UK
  1. Correspondence to:
 Mr T J Coats, Accident and Emergency Department, Royal London Hospital, Whitechapel, London E1 1BB, UK;


Objective: To define the ability of UK paramedics to recognise ST segment elevation using a prehospital 12 lead electrocardiogram (ECG).

Methods: Analysis of the diagnostic ability of seven paramedics 12 months after a two day training course, using interpretation of a 12 lead ECG by two cardiologists as the criterion standard. Comparison of paramedic and A&E SHO diagnosis to determine accuracy, specificity, sensitivity, negative predictive value, and positive predictive value of paramedic interpretation.

Results: Paramedics showed a median accuracy of 0.95 (95% CI 0.88 to 0.98), a specificity of 0.91 (95% CI 0.53 to 1.0), a sensitivity of 0.97 (95% CI 0.94 to 0.99), a NPV of 0.77 (95% CI 0.62 to 0.92) and a PPV of 0.99 (95% CI 0.92 to 1.0). This was not significantly different from a group of experienced A&E SHOs.

Conclusions: UK paramedics can recognise ST elevation using a 12 lead ECG. Radio transmission of an ECG may not be necessary to pre-alert the hospital.

  • electrocardiography
  • myocardial infarction
  • emergency medical technicians
  • AMI, acute myocardial infarction
  • ECG, electrocardiogram
  • PPV, positive predictive value
  • NPV, negative predictive value

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