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SPECIAL ARTICLE

Pre-Hospital 12-Lead Electrocardiography Programs

A Call for Implementation by Emergency Medical Services Systems Providing Advanced Life Support—National Heart Attack Alert Program (NHAAP) Coordinating Committee; National Heart, Lung, and Blood Institute (NHLBI); National Institutes of Health

J. Lee Garvey, MD^_*, Bruce A. MacLeod, MD, FACEP, George Sopko, MD, Mary M. Hand, MSPH, RN^,_* on behalf of the National Heart Attack Alert Program (NHAAP) Coordinating Committee

^_* Carolinas Medical Center, Charlotte, North Carolina
Mercy Hospital of Pittsburgh, Pittsburgh, Pennsylvania
National Heart, Lung, and Blood Institute, Bethesda, Maryland.

Manuscript received August 4, 2005; accepted August 23, 2005.

^_* Reprint requests and correspondence: Mary Hand, MSPH, RN, c/o NHLBI Information Center, P.O. Box 30105, Bethesda, Maryland 20824. (Email: NHLBIinfo{at}nhlbi.nih.gov).

Emergency medical services (EMS) providers who administer advanced life support should include diagnostic 12-lead electrocardiography programs as one of their services. Evidence demonstrates that this technology can be readily used by EMS providers to identify patients with ST-segment elevation myocardial infarction (STEMI) before a patient’s arrival at a hospital emergency department. Earlier identification of STEMI patients leads to faster artery-opening treatment with fibrinolytic agents, either in the pre-hospital setting or at the hospital. Alternatively, a reperfusion strategy using percutaneous coronary intervention can be facilitated by use of pre-hospital 12-lead electrocardiography (P12ECG). Analysis of the cost of providing this service to the community must include consideration of the demonstrated benefits of more rapid treatment of patients with STEMI and the resulting time savings advantage shown to accompany the use of P12ECG programs.

Abbreviations and Acronyms   ACC = American College of Cardiology   ACI-TIPI = acute cardiac ischemia time-insensitive predictive instrument   ACS = acute coronary syndromes   AHA = American Heart Association   AHRQ = Agency for Healthcare Research and Quality   ALS = advanced life support   AMI = acute myocardial infarction   ED = emergency department   EMS = emergency medical services   EMT-P = emergency medical technician-paramedic   PCI = percutaneous coronary intervention   P12ECG = pre-hospital 12-lead electrocardiography   STEMI = ST-segment elevation myocardial infarction

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