The October 2006 issue of EMS Magazine featured an article on out-of-hospital 12-lead ECG programs and EMS systems that have created pathways to reduce the time interval between scene arrival and balloon inflation in the cardiac catheterization lab for patients with ST segment-elevation myocardial infarction (STEMI).¹ This issue features an article on Tampa Fire Rescue's 12-lead acquisition and transmission program (see Distant Early ECG Warning, p. 43). Entities such as the Centers for Medicare and Medicaid Services (CMS), the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) and various physician professional societies are now mandating reductions in the time it takes emergency departments to obtain 12-lead ECGs for potential acute coronary syndrome patients and in door-to-balloon times for emergency cardiac catheterization.

     A landmark article published in the New England Journal of Medicine last November quantified average time savings at 365 hospitals that had implemented changes to reduce the interval from patient arrival in the ED to balloon inflation in the cardiac cath lab (see Door-to-Balloon Time-Saving Tips, page 54).² The current standard is 90 minutes, which is quite a difficult mark to achieve unless there's a focused internal marketing campaign and a large expenditure of money. Of the authors' six recommendations, EMS acquisition, interpretation and transmission of 12-lead ECGs was found to save more time (15.4 minutes) than any other intervention except requiring cath lab personnel to respond to the hospital within 20 minutes of being paged. The potential impact of this research was compared to the invention of CPR in terms of the lives that could be saved if the recommendations were acted upon.

     One of my favorite citations to point out how ridiculous it is that we still don't have widespread capability to diagnose patients with STEMIs, institute aggressive EMS care and move them toward cath labs is from the premiere episode of Emergency! This show depicted what was actually happening in the early 1970s as Los Angeles County implemented one of the first ALS systems in the country. If you listen carefully to the discussion between Gage and DeSoto during their tour of the new Squad 51 (paramedic responder/light rescue vehicle), there's distinct mention that the Datascope cardiac monitor is capable of acquiring and transmitting full 12-lead ECGs.