12-Lead Interpretation in the Field

[Dustdevil]

Dang, Spykes! Long time, no see!

This must be reunion day for long lost members!

[mshow00]

"But we have 2,500 paramedics [and 27 provider agencies] in L.A. County," Rokos said, "And obviously we can't train everyone to read ECGs." So Los Angeles County has paramedics rely on an automated computer ECG interpretation. "All they have to do is read ***Acute MI, and that's their ticket to go," he said.

Is there a program that can actually read the ECG correctly 100% of the time? My company uses the Philliaps 12 lead moniters and it analizes the ECG at the end, however I have noticed that more often than not, it is wrong. Most recently we transported a female vent Pt over 40 with sever rep. distress; when we ran the 12 lead it read Acute Infirior MI. We transmitted the results to the ED. When we got the the hospital we were told to put the Pt in a room. Confused as to why, I respectfully asked the Dr. why. He broke the 12 lead down for me and my partner that in lead to there was a PR depresion not ST elevation, and that ment they pt was not having a MI instead ment the pt has/had hypertrophy of the heart. My medic partner missed it, and the 12 lead misread it.

[AZCEP]

None of the current software is all that good at interpretation, and they shouldn't be expected to be. At best, the computer will be close to right 50% of the time. The providers have to be able to identify when it is wrong.

[p3medic]

On the LP12 you can disable to computer interpretation feature.

[air.stump]

When ever something new in prehospital treatment comes around, the EMS community embraces it and goes about training crews and making sure they know how to use it. At the same time, the area EMS councils meet resistance from the area hospitals and their staff. As the hospital staff becomes familiar with the new technology or procedures, they are more comfortable with it and are accepting of it more.

When we initiated 12 leads, we would run them, interrupt them and then get the QA guys to compare them with what the hospital saw when they ran theirs. It was an effective tool that got us past the transmitting stage and showed that we could knew our job.

Good luck and don't let it get you down. It isn't personal.

[Dustdevil]

When I run a 12 lead and the auto-interpretation comes up with "MI", it does give me reason to slow down, back up, and take a good, close look at both the EKG and the patient. It does not, however, tell me there is actually an MI present. In fact, I'd say the majority of the time it simply makes me run another one ten seconds later and get one that does not say MI on it. Funny how that works.

[UMSTUDENT]

When I run a 12 lead and the auto-interpretation comes up with "MI", it does give me reason to slow down, back up, and take a good, close look at both the EKG and the patient. It does not, however, tell me there is actually an MI present. In fact, I'd say the majority of the time it simply makes me run another one ten seconds later and get one that does not say MI on it. Funny how that works.

I agree, the chief of our department ordered the recognition software turned off almost two years ago. It was his way of showing the powers at be that he believed his paramedics to be well-trained and capable. Plus, it forced the few that were not properly reading their 12-Leads to learn it or leave.

Unfortunately, I have to agree with Dust that these little "alerts" do serve to tip you off to things you may not have immediately noticed before. Plus, I've found the Phillips software relatively good at arrhythmia recognition. I don't know about others using the Phillips MRx, but I find it to have a fairly crappy baseline and very non-intuitive gain amplification. Subtle A-Fib (not obviously irregularly irregular) often gets pushed aside by our providers as simply a sinus rhythm with a crappy baseline (instead of 'f' waves). For some reason though, the software seems to fairly regularly look through and properly differentiate.

[HellsBells]

But we have 2,500 paramedics [and 27 provider agencies] in L.A. County," Rokos said, "And obviously we can't train everyone to read ECGs." So Los Angeles County has paramedics rely on an automated computer ECG interpretation. "All they have to do is read ***Acute MI, and that's their ticket to go," he said.

Why can't you train everyone to read ecg's? Isn't that a Paramedics job?

Hmm, I wonder if L.A. County is going to get rid of all their manual BP cuffs, and replace them with automated ones because " Obviously they can't train everyone to auscultate a Blood Pressure."

[CBEMT]

I find it hard to believe that there are paramedic schools that are not teaching even basic 12-lead interpretation.

[Ridryder 911]

I find it hard to believe that there are paramedic schools that are not teaching even basic 12-lead interpretation.

Oh do believe it. I know at least three that are NOT. As well, there are still very few that are using the 12 lead around here, even some that can but will not... shameful!

R/r 911