Zègre-Hemsey Jessica K, Patel Mehul D, Fernandez Antonio R, Pelter Michele M, Brice Jane, Rosamond Wayne
Prehosp Emerg Care. 2020 Jul-Aug;24(4):550-556. doi: 10.1080/10903127.2019.1677831. Epub 2019 Oct 31.
The American Heart Association recommends acquiring and interpreting prehospital electrocardiograms (ECG) for patients transported by Emergency Medical Services (EMS) to the emergency department with symptoms highly suspicious of acute coronary syndrome. If interpreted correctly, prehospital ECGs have the potential to improve early detection of ST-elevation myocardial infarction (STEMI) and inform prehospital activation of the cardiac catheterization laboratory, thus reducing total ischemic time and improving patient outcomes. Standardized protocols for prehospital ECG interpretation methods are lacking due to variations in EMS system design, training, and procedures. We aimed to describe approaches for prehospital ECG interpretation in EMS systems across North Carolina (NC), and examine potential differences among systems. A 35-item internet survey was sent to all NC EMS systems ( = 99). Questions pertaining to prehospital ECG interpretation methods included: paramedic, computerized algorithm (i.e., software interpretation), combined approaches, and/or transmission for physician interpretation, transmission capability, cardiac catheterization laboratory activation, and EMS system characteristics (e.g. rural versus urban). Data were summarized and compared. A total of 96 EMS systems across NC responded to the survey (97% response rate); of these, 69% were rural. EMS medical directors (53%) or EMS administrative directors (42%) completed the majority of surveys. While 91% of EMS systems had a prehospital ECG interpretation protocol in place, only 61% had a written cardiac catheterization laboratory activation policy. More than half (55%) of systems reported paramedic interpretation of prehospital ECGs, followed by a combined paramedic and software interpretation approach (39%), physician interpretation (4%), or software interpretation only approach (2%). Nearly 80% of EMS systems transmitted prehospital ECGs to receiving hospitals (always or sometimes), regardless of interpretation method. All EMS systems had some paid versus non-paid EMS personnel and the majority (86%) had both basic and advanced life support capabilities. Most NC EMS systems had a paramedic only ECG interpretation or paramedic in combination with a computerized algorithm approach. Very few used a physician read approach following transmission, even in rural service areas.
美国心脏协会建议，对于由紧急医疗服务（EMS）送往急诊科、症状高度怀疑为急性冠状动脉综合征的患者，应获取并解读院前心电图（ECG）。如果解读正确，院前心电图有可能改善ST段抬高型心肌梗死（STEMI）的早期检测，并为心脏导管实验室的院前启动提供信息，从而减少总缺血时间并改善患者预后。由于EMS系统设计、培训和程序的差异，缺乏院前心电图解读方法的标准化方案。我们旨在描述北卡罗来纳州（NC）各地EMS系统中院前心电图解读的方法，并研究各系统之间的潜在差异。向所有NC EMS系统（n = 99）发送了一份包含35个项目的网络调查问卷。与院前心电图解读方法相关的问题包括：护理人员解读、计算机算法（即软件解读）、联合方法和/或传输给医生解读、传输能力、心脏导管实验室启动以及EMS系统特征（如农村与城市）。对数据进行了总结和比较。北卡罗来纳州共有96个EMS系统回复了调查（回复率为97%）；其中，69%为农村地区。大多数调查问卷由EMS医疗主任（53%）或EMS行政主任（42%）完成。虽然91%的EMS系统制定了院前心电图解读方案，但只有61%有书面的心脏导管实验室启动政策。超过一半（55%）的系统报告由护理人员解读院前心电图，其次是护理人员与软件联合解读方法（39%）、医生解读（4%）或仅软件解读方法（2%）。近80%的EMS系统将院前心电图传输给接收医院（总是或有时），无论解读方法如何。所有EMS系统都有一些有偿和无偿的EMS人员，大多数（86%）具备基本和高级生命支持能力。北卡罗来纳州的大多数EMS系统采用仅由护理人员解读心电图或护理人员与计算机算法相结合的方法。即使在农村服务地区，很少有系统在传输后采用医生解读的方法。
