Who Requires a Prehospital 12 Lead ECG?

Who Requires a Prehospital 12 Lead ECG?

Patients ≥ 35 years old experiencing any of the following:

  • Chest pain or discomfort
  • Chest pressure or tightness
  • “Heartburn” or epigastric pain
  • Complaints of “heart racing” (HR >150 or irregular and >120)
  • Complaints of “heart too slow” (HR <50 and symptomatic)
  • Syncope
  • Severe weakness
  • New onset stroke symptoms (<24 hours old)
  • Difficulty breathing (with no obvious non-cardiac cause)

Patients (regardless of age) with any of the above symptoms and history of:

  • Prior cardiac disease
  • A family history of early heart disease
  • Diabetes
  • Severe obesity
  • Recent cocaine use
  • Suspected overdose

Patients (regardless of age) who:

  • Have had a recent electrical injury
  • If the provider has any doubt or uncertainty about the patient’s condition.


Women and diabetic patients are more likely to present with atypical symptoms.  Elderly patients may have symptoms such as generalized weakness, altered mental status or syncope as their only sign of acute heart attack.

Transmit the ECG to the receiving facility. If multiple 12-leads are obtained, transmit the one(s) that influenced your treatment decision(s).


The 12-lead monitor (when available) should routinely be carried in to the patient’s house upon EMS arrival and a 12-lead should be obtained (for these patients) as soon as possible (goal = within 10 minutes of first medical contact).

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