TAKING THE LEAD WITH THE ECG

The 12-lead ECG is a fundamental component of patient assessment for a range of presentations and is almost universally available across a variety of healthcare settings. In prehospital care, 12-lead ECG equipment has become standard in ambulance services and is recommended in international guidelines for cardiac care.¹

Despite this, there is evidence that the prehospital ECG (PHECG) is underutilised. In the USA, for example, less than 10% of patients with acute ST segment elevation myocardial infarction have a PHECG, according to the National Registry of Myocardial Infarction, a rate that has not substantially improved in the past decade.² Experience from the UK, although not yet published, suggests much higher use, with approximately three-quarters of patients with ST segment elevation myocardial infarction who were under emergency medical services care having a PHECG recorded.

The American Heart Association have published a scientific statement setting out the available evidence, alongside practice recommendations and possible questions for future research. This covers the perceived benefits of PHECG, skill and competence in acquisition, interpretation and communication of ECG findings by emergency medical services staff, organisational and system issues and possible barriers to implementation.

A key practice recommendation is that the PHECG should take priority over other components of care such as oxygen and opiate administration, facilitating …