12 Lead ECGs need to be obtained for ALL patients complaining of chest pain for which acute coronary syndrome (ACS) is a consideration.
In recognition for our efforts, we recently were awarded the Mission Lifeline Bronze Award from the American Heart Association.
Regarding 12 Lead ECGs, the Mission: Lifeline achievement measure with which we are concerned is the percentage of patients with non-traumatic chest pain > 35 years, treated and transported by EMS who receive a pre-hospital 12-lead electrocardiogram.
At this time, based on our 2015 first- and second-quarter performance, we are eligible to receive at least the Bronze award again next year! However, we don’t want to settle for Bronze, so keep up the great work and we can achieve Silver!
How are we doing for 12 Lead ECG aquisition?
For the first quarter (January-March), 91% of the patients that met the criteria (non-traumatic chest pain, > 35 years of age) received pre-hospital ECGs. For the second quarter, 96% received pre-hospital ECGs. That is awesome, but there is always room for improvement!
- If you have a primary or secondary impression that includes chest pain (which you should use only if you believe your patient is having cardiac-related chest pain), you need to acquire, import, and document a 12 Lead ECG (in the procedure section and the ECG section). If the chest pain is caused by something non-cardiac (e.g., trauma, breathing difficulty, etc.), that other cause needs to be documented as your impression/diagnosis, not “chest pain”.
- BLS providers who have taken the department’s 12 Lead ECG training should not wait for ALS arrival to obtain a 12 Lead ECG
- ALS providers may use sound clinical decision-making skills with a comprehensive assessment of the patient and an evaluation of the totality of all circumstances and may ultimately turn the patient over to a BLS crew after obtaining a 12 Lead ECG if the ALS provider determines the patient does not warrant an ALS transport.
Acquire the 12 Lead ECG within 10 minutes of First Medical Contact.
First Medical Contact (FMC) is the time of eye-to-eye contact between the STEMI patient and the caregiver capable of performing a 12 Lead ECG. The pathway to early reperfusion of the STEMI patient begins with early 12 Lead ECG acquisition.
The best way to accomplish this goal is to take the LifePak with you to the patient. If you’re dispatched to anything that could be cardiac-related, in addition to the stretcher and jump bag, take the LifePak with you (along with any other call-specific items you may need). Leaving the LifePak inside the ambulance and waiting until the patient is in the ambulance to acquire a 12 Lead ECG wastes precious time. The sooner we can acquire and transmit the 12 Lead ECG, the sooner we can notify the Emergency Department, the sooner the cardiology team will be notified, the sooner the patient will be in the cath. lab, and the sooner heart muscle will be saved!
At this time, the time from FMC to 12 Lead ECG is only a reporting measure (not related to achieving the award), but it may become a required achievement measure in the future and we want to demonstrate our excellence!
The patient’s heart thanks you for taking the LifePak with you to the patient’s side!
Remember to import the LifePak data into your ePCR every time you acquire a 12 Lead ECG!
Also, transmit every 12 Lead ECG to the hospital!