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In a scientific statement, the American Heart Association (AHA) is pushing hospital systems to integrate prehospital ECGs into care for patients with acute coronary syndromes. Lead author Henry H. Ting, MD, notes that hospital systems have generally done a good job reducing "door-to-balloon" times in patients with ST-segment-elevation myocardial infarction (STEMI) by coordinating care between EDs, cath labs, and other key departments within hospitals. But from the patient's viewpoint, treatment begins at first contact with any health care professional, which is often EMS personnel.


Many EMS systems currently have the technology to assess patients for STEMI, but hospital systems may lack protocols to put the information to good use. As a result, patients may lose valuable time waiting for an initial or duplicate ECG when they arrive at the hospital ED.


The AHA statement urges hospital systems to develop protocols to incorporate prehospital ECGs into the patient's hospital care. Methods for interpreting prehospital ECGs include use of computer algorithms, paramedic interpretation, and wireless transmission to a hospital physician.


The goal is to initiate appropriate treatment as soon as STEMI is detected. "If you detect ST elevation, the next steps are very different than treating a patient who has chest pain but no ST elevation," notes Dr. Ting, who also calls for educating the public about the value of activating EMS. The public tends to view EMS as "transportation with sirens," Ting says. "They think, 'If Uncle Joe can drive me there just as fast, why do I need to call 911?'[horizontal ellipsis]But the prehospital ECG can really change the course of treatment."




Ting HH, Implementation and integration of prehospital ECGs into systems of care for acute coronary syndrome, Circulation, published online before print August 13, 2008; O'Riordan M, AHA publishes statement on integrating prehospital ECGs into care for ACS patients, HeartWire, from WebMD, August 13, 2008.