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Ability of First-Year Paramedic Students to Identify ST-Segment Elevation Myocardial Injury on 12-Lead Electrocardiogram: A Pilot Study

Published online by Cambridge University Press:  28 June 2012

Joel T. Levis  and
Mary Koskovich
Joel T. Levis*
Affiliation:
Foothill College Paramedic Program, Palo Alto, California, USA Department of Emergency Medicine, Kaiser Santa Clara Medical Center, Santa Clara, California, USA
Mary Koskovich
Affiliation:
Foothill College Paramedic Program, Palo Alto, California, USA
*
4000 Middlefield Road, Suite I, Palo Alto, California 94303, USA E-mail: [email protected]
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Abstract

Introduction:

The purpose of this study was to evaluate the ability of first-year paramedic students to identify ST-segment elevation myocardial injury (STEMI) on 12-lead electrocardiograms (ECGs) following a three-hour presentation by a board-certified emergency medicine physician experienced in ECG interpretation.

Methods:

Thirty-three first-year paramedic students with minimal to no experience in evaluating 12-lead ECGs were administered a pretest with 20 12-lead ECGs and were asked to evaluate each for: (1) presence of STEMI (STEMI identification); (2) if STEMI presents, ECG leads demonstrating ST-elevation (LEAD identification); and (3) if STEMI present, the anatomic distribution of the STEMI (ANATOMY identification). The students were randomized into two groups. Group 1 (16 students; control group) received a handout describing the evaluation of ECGs for STEMI, while Group 2 (17 students; experimental group) received the handout plus a threehour presentation on the evaluation of ECGs for STEMI. Following randomization, distribution of the STEMI handout and ECG STEMI presentation, a posttest with 20 new ECGs was administered to all participants. The pretest and posttest mean scores were compared between the two groups to determine if attendance at the presentation improved the paramedic students' abilities to evaluate and identify STEMI ECGs. Following the STEMI posttest, students in Group 1 were provided with the STEMI lecture. Students were retested with 20 new ECGs five months following the initial study to examine retention of the information taught.

Results:

The mean pre-test scores for the two groups (Group 1 vs Group 2, respectively) in STEMI identification (74.4 vs 75.6%; p = 0.79), lead identification (50.0 vs. 51.2%; p = 0.8) and anatomy identification (49.4 vs 51.8%; p = 0.60) were similar in all three categories. Post-test scores between Group 1 and Group 2 demonstrated statistically significant differences in STEMI identification (85.6 vs 92.4%; p <0.02), lead identification (73.4 vs 85.2%; p <0.02), and anatomy identification (65.9 vs 87.1%; p <0.01), with Group 2 demonstrating higher mean scores relative to Group 1 in all three categories. Comparison of mean initial pre-test and five-month retest scores for all students demonstrated statistically significant differences in STEMI identification (75.0 vs 87.4%; p <0.0001), lead identification (50.6 vs 82.2%; p <0.0001), and anatomy identification (50.6 vs 76.6%; p <0.0001).

Conclusions:

The ability of first-year paramedic students to accurately detect STEMI on prehospital 12-lead ECGs is enhanced by a structured ECG STEMI presentation provided by an emergency medicine physician, and these students maintained excellent retention of STEMI ECG skills over a five-month period.

Keywords

myocardial infarctionparamedic studentST-segment
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 25 , Issue 6 , December 2010 , pp. 527 - 532
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2010

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References

1.Granger, CB: Accelerating ST-segment elevation myocardial infarction care (editorial comment). JACC Cardiovasc Intervent 2009;2:347–349.CrossRefGoogle Scholar
2.Ting, HH, Krumholz, HM, Bradley, EH, et al: Implementation and integration of prehospital ECGs into systems of care for acute coronary syndromes: A scientific statement from the American Heart Association Interdisciplinary Council on Quality of Care and Outcomes Research, Emergency Cardiovascular Care Committee, Council on Cardiovascular Nursing, and Council on Clinical Cardiology. Circulation 2008;118:1066–1079.CrossRefGoogle ScholarPubMed
3.Antman, EM, Anbe, DT, Armstrong, PW, et al: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction—Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction). Circulation 2004;110:588–636.Google Scholar
4.ECC Committee, Subcommittees and Task Force of the American Heart Association: 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2005;112(suppl IV):IV–1.Google Scholar
5.Antman, EM, Hand, M, Armstrong, PW, et al: 2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: Development in collaboration with the Canadian Cardiovascular Society, endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the management of patients with ST-elevation myocardial infarction. Writing on behalf of the 2004 Writing Committee. Circulation 2008;117:296–329.CrossRefGoogle Scholar
6.Terkelsen, CJ, Lassen, JF, Norgaard, BL, et al: Reduction in treatment delay in patients with ST-elevation myocardial infarction: Impact of pre-hospital diagnosis and direct referral to primary percutaneous coronary intervention. Eur Heart J 2005;26:770–777.CrossRefGoogle Scholar
7.Morrison, LJ, Brooks, S, Sawadsky, B, et al: Prehospital 12-lead electrocardiography impact on acute myocardial infarction treatment times and mortality: A systemic review. Acad Emerg Med 2006;13:84–89.Google Scholar
8.Brown, JP, Mahmud, E, Dunford, JV, et al: Effect of prehospital 12-lead electrocardiogram on activation of the cardiac catheterization laboratory and door-to-balloon time in ST-segment elevation acute myocardial infarction. Am J Cardiol 2008;101:158–161.CrossRefGoogle ScholarPubMed
9.Rokos, IC, French, WJ, Koenig, WJ, et al: Integration of pre-hospital electrocardiograms and ST-elevation myocardial infarction receiving center (SRC) networks. JACC Cardiovasc Intervent 2009;2:339–346.CrossRefGoogle ScholarPubMed
10.Eckstein, M, Cooper, E, Nguyen, T, et al: Impact of paramedic transport with prehospital 12-lead electrocardiography on door-to-balloon times for patients with ST-segment elevation myocardial infarction. Prehosp Emerg Care 2009;13:203–206.CrossRefGoogle ScholarPubMed
11.Canto, JG, Rogers, WJ, Bowlby, LJ, et al: The prehospital electrocardiogram in acute myocardial infarction: Is its full potential being realized? National Registry of Myocardial Infarction 2 Investigators. J Am Coll Cardiol 1997;29:498–505.CrossRefGoogle Scholar
12.Curtis, JP, Portnay, EL, Wang, Y, et al: The pre-hospital electrocardiogram and time to reperfusion in patients with acute myocardial infarction. 2000-2002: findings from the National Registry of Myocardial Infarction-4. J Am Coll Cardiol 2006;47:1544–1552.CrossRefGoogle Scholar
13.Hill, R, Heller, M, Rosenau, A, et al: Paramedic interpretation of prehospital lead-II ST-segments. Prehosp Disaster Med 1997;12:141–144.CrossRefGoogle ScholarPubMed
14.Brinfield, K: Identification of ST elevation AMI on prehospital 12 lead ECG: Accuracy of unaided paramedic interpretation. J Emerg Med 1998;16:s22.Google Scholar
15.Ioannidis, JP, Salem, D, Chew, PW, et al: Accuracy and clinical effect of outof-hospital electrocardiography in the diagnosis of acute myocardial ischemia: A meta-analysis. Ann Emerg Med 2001;37:461–470.CrossRefGoogle Scholar
16.Whitbread, M, Leah, V, Bell, T, et al: Recognition of ST elevation by para-medics. Emerg Med J 2002;19:66–67.CrossRefGoogle Scholar
17.Feldman, JA, Brinsfield, K, Bernard, S, et al: Real-time paramedic compared with blinded physician identification of ST-segment elevation myocardical infarction: Results of an observational study. Am J Emerg Med 2005;23:443–448.CrossRefGoogle Scholar
18.Le May, MR, Dionne, R, Maloney, J, et al: Diagnostic performance and potential clinical impact of advanced care paramedic interpretation of ST-segment elevation myocardial infarction in the field. CJEM 2006;8:401–407.CrossRefGoogle ScholarPubMed
19.Trivedi, K, Schuur, JD, Cone, DC: Can paramedics read ST-segment elevation myocardial infarction on prehospital 12-lead electrocardiograms? Prehosp Emerg Care 2009;13:207–214.CrossRefGoogle ScholarPubMed
20.Williams, B, Boyle, M, Lord, B: Paramedic identification of electrocardiograph J-point and ST-segments. Prehosp Disaster Med 2008;23:526–529.CrossRefGoogle ScholarPubMed
21.National Highway Traffic Safety Administration: Part IV medical cardiology declarative. Section VE 3.a. EMT-paramedic national standard. Washington, DC;1999:15.Google Scholar
22.Amersterdam, EA, Kirk, JD, Bluemke, DA, et al: Testing of low-risk patients presenting to the emergency department with chest pain. A scientific statement from the American Heart Association. Circulation 2010;122:1756–1776.CrossRefGoogle Scholar