EMS providers are frequently required to perform an assessment of the chest pain patient that includes the performance of a 12-lead ECG; many EMS systems have standing protocols for chest pain patients that include obtaining a 12-lead ECG. The 12-Lead ECG is essential to appropriate field chest pain triage. Paramedics can reliably obtain a 12-lead ECG, but as few as 5% of patients receive a field ECG. We hypothesized that replacing the traditional multiple ECG pads with a single patch (6 lead) applicator (CardioQuick Patch) would improve protocol compliance with appliction of the 12-lead ECG.

 

 

This observational study compared compliance with 12 Lead ECG acquisition protocols on chest pain patients before and after implementing the new device. 12 Lead ECG compliance was estimated for June and July in both 2005 and 2006. Continuing medical education which emphasized the use of the 12-lead ECG was provided to EMS personnel between the two periods. Education was reinforced just prior to the second time period when the new device was made available. All charts for each period containing chest pain in the chief complaint, provider impression or in the narrative were identified, and performance of a 12-lead ECG was documented. Difference in proportions of patients with a 12-lead ECG were computed, and logistic regression was used to evaluate the change in odds of getting a 12-lead ECG adjusted for age, race and sex.

 

Although compliance with protocol remained below 50%, compliance did increase between 2005 and 2006 when the new 12-lead device was introduced.

 

 

This study used historical controls; it is possible that practice patterns changed between years. We did select similar times of year for comparisons to eliminate seasonal effects. Education may have been a determinant of compliance in addition to provision of the CardioQuick Patch.