Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Allowing EMTs to perform an ECG should not be controversial

William C. Dillon, MD
Conditions
January 17, 2013
Share
Tweet
Share

I live in Louisville, KY, which is the epicenter for heart disease in the United States. My state ranks 49th out of 50 states for heart attack mortality. This is a complex issue with many contributing factors, including access to care, patient education, health insurance, cooperation between EMS and hospitals, among others. The thing is: heart disease is our number one killer. So it matters.

We have been building a regional heart attack network at our institution. Patients with acute heart attack are best served by emergency percutaneous coronary intervention (PCI). It’s amazing. One minute the patient is writhing and literally dying, and in the next moment after a PCI they are pain free and getting up off the table. I’ve been on interventional call this last week and spent a couple of late nights in the cath lab. Needless to say, I was looking forward to the family vacation and getting away to recharge my batteries.

I arrived at the airport with my family and was walking toward the TSA area when I saw him. Off to the side was a middle-aged man slumped against the wall. He was ashen with a light sheen of sweat on his forehead and his hand on his chest (Levine sign). I’ve seen this look a thousand times. This guy is having a heart attack. I go over and identify myself as a cardiologist to the security guard and ask, “Can I help?”

The man pleads: “Can somebody make this chest pain go away?” I think, yes I can. Let’s go. I’ll take you up to the cath lab and have this over in 20 minutes. Except, I’m outside the TSA line at the airport. I don’t have my cath lab team or my fluoroscopy machine or my angioplasty balloon. Heck, I don’t even have an ECG. What a helpless feeling. There is one guy in the building, me, that can stop this heart attack and I am stuck just watching.

EMS is on the scene minutes later. Yes, the cavalry has arrived. I tell the EMS personnel that I’m a cardiologist and I think this guy is having a heart attack. “We need a 12 lead ECG now.” The EMS personnel respond: “We can’t do an ECG because we are a basic life support ambulance.” Are you kidding me? I think to myself.

An abnormal ECG is the portal to entry for heart attack care and the key to unleashing the fury of modern day medicine to save this guys life. Once the ECG is abnormal, a cath lab team can be activated.

EMS in my county—an urban area–is great and they do a wonderful job. But it turns out there is up to a 50% chance that when an ambulance pulls up on a scene they can’t provide even an ECG. It’s the same in many areas in my state and throughout the country. If a paramedic is on board then an ECG is done at the scene and it is transmitted to the PCI center. However, for a variety of reasons, in most locales, basic EMTs are not allowed to perform ECGs. This means the diagnosis of heart attack has to wait until arrival in the ER. That’s a significant delay–and it makes no sense.

ECGs are cheap to do, easy to perform and confer no risk to the patient. The accompanying computer software correctly recognizes a heart attack the vast majority of the time. The recently released heart attack guidelines for the US have as the second recommendation “performance of a 12-lead ECG by EMS personnel at the site of first medical contact (FMC) is recommended in patients with symptoms consistent with STEMI.” Furthermore, just last month in JACC Intervention a study was published showing a greater than 50% reduction in mortality with pre-hospital activation of the cath lab during STEMI care.

Back to our patient. We gave him aspirin and I told the EMT to go to the nearest PCI center—although without an ECG there would be no pre-activation of the cath lab. I called the PCI center and identified myself as a cardiologist, I don’t practice at that institution, and explained the situation to the ED physician. Once the patient arrived at the PCI center he was diagnosed with a heart attack and underwent successful PCI.

Standing there with this patient and not being able to offer any more than aspirin, oxygen and rapid transfer to a PCI center was a very frustrating and helpless feeling for me. It strengthened my resolve to improve the process of heart attack care.

I am working with our state EMS board to allow all EMTs to perform ECGs. We have to improve access to state of the art heart attack care.

Acute heart attack care is surely a complex issue, but allowing EMTs to perform an ECG should not be controversial. It should be an easy step forward in treating our number one killer. Time is of the essence. Speed is life and death.

William C. Dillon is an interventional cardiologist and can be reached on Twitter @Wmdillon.

ADVERTISEMENT

Image credit: Shutterstock.com

Prev

Is our system built upon a flawed foundation of fee for service?

January 17, 2013 Kevin 8
…
Next

Doctors should never treat their families: Easier said than done

January 17, 2013 Kevin 1
…

Tagged as: Cardiology

Post navigation

< Previous Post
Is our system built upon a flawed foundation of fee for service?
Next Post >
Doctors should never treat their families: Easier said than done

ADVERTISEMENT

More in Conditions

  • Clinical ghosts and why they haunt our exam rooms

    Kara Wada, MD
  • High blood pressure’s hidden impact on kidney health in older adults

    Edmond Kubi Appiah, MPH
  • How declining MMR vaccination rates put future generations at risk

    Ambika Sharma, Onyi Oligbo, and Katrina Green, MD
  • How one unforgettable ER patient taught a nurse about resilience

    Kristen Cline, BSN, RN
  • Why regular exercise is the best prescription for lifelong health

    George F. Smith, MD
  • When the weight won’t budge: the hidden physiology of grief, stress, and set point

    Sarah White, APRN
  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • Addressing menstrual health inequities in adolescents

      Callia Georgoulis | Conditions
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
  • Recent Posts

    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • Clinical ghosts and why they haunt our exam rooms

      Kara Wada, MD | Conditions
    • High blood pressure’s hidden impact on kidney health in older adults

      Edmond Kubi Appiah, MPH | Conditions
    • Deep transcranial magnetic stimulation for depression [PODCAST]

      The Podcast by KevinMD | Podcast
    • How declining MMR vaccination rates put future generations at risk

      Ambika Sharma, Onyi Oligbo, and Katrina Green, MD | Conditions
    • The physician who turned burnout into a mission for change

      Jessie Mahoney, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 15 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • Addressing menstrual health inequities in adolescents

      Callia Georgoulis | Conditions
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
  • Recent Posts

    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • Clinical ghosts and why they haunt our exam rooms

      Kara Wada, MD | Conditions
    • High blood pressure’s hidden impact on kidney health in older adults

      Edmond Kubi Appiah, MPH | Conditions
    • Deep transcranial magnetic stimulation for depression [PODCAST]

      The Podcast by KevinMD | Podcast
    • How declining MMR vaccination rates put future generations at risk

      Ambika Sharma, Onyi Oligbo, and Katrina Green, MD | Conditions
    • The physician who turned burnout into a mission for change

      Jessie Mahoney, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Allowing EMTs to perform an ECG should not be controversial
15 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...