Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-18T17:01:22.897Z Has data issue: false hasContentIssue false

Planning, Implementation, and Process Monitoring for Prehospital 12-Lead ECG Diagnostic Programs

Published online by Cambridge University Press:  28 June 2012

Tom P. Aufderheide*
Affiliation:
Associate Professor of Emergency Medicine, Medical College of Wisconsin, Department of Emergency Medicine, Milwaukee, Wisconsin
Dean J. Kereiakes
Affiliation:
Director, Division of Cardiovascular Intervention, Cardiovascular Research Center,The Christ Hospital, Cincinnati, Ohio
W. Douglas Weaver
Affiliation:
Director, Cardiac Critical Care, University of Washington Medical Center, Professor of Medicine, University of Washington School of Medicine, Seattle, Washington
W. Brian Gibler
Affiliation:
Richard C, Levy Professor of Emergency Medicine and Chairman, Department of Emergency Medicine,University of Cincinnati Medical Center, Cincinnati, Ohio
Maarten L. Simoons
Affiliation:
Professor of Clinical Cardiology, Thoraxcenter, University Hospital, Rotterdam, The Netherlands
*
Medical College of Wisconsin, Department of Emergency Medicine, 9200 West Wisconsin Avenue, FMLH East, Milwaukee, WI 53226, USA

Abstract

Prehospital 12-lead electrocardiographic (ECG) diagnostic strategies have been proven feasible and effective, provided they are designed and implemented properly. The authors of this communication have expended considerable time and effort in determining appropriate planning, implementation, and process monitoring necessary for successful implementation of a variety of prehospital diagnostic strategies. Many of these issues may not be obvious to an emergency medical services (EMS) director initiating a 12-lead ECG program. This level of attention to protocol development, education, training, inservice education, coordination of the health-care community, objective program assessment, monitoring and continuos quality improvement can serve as a model for other diagnostic EMS programs that may develop as an expanded role for EMS.

Type
Special Report
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1996

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Rawles, J, on Behalf of the GREAT Group: Halving of mortality at 1 year by domiciliary thrombolysis in the Grampian Region Early Anistreplase Trial (GREAT). J Am Coll Cardiol 1994;23:15.CrossRefGoogle Scholar
2. Weaver, WD, Cerqueira, MD, Hallstrom, AP, et al. : Prehospital-initiated vs hospital-initiated thrombolytic therapy. JAMA 1993;270:12111216.CrossRefGoogle ScholarPubMed
3. Simoons, ML and The European Myocardial Infarction Project Group (EMIP): Prehospital thrombolytic therapy in patients with suspected acute myocardial infarction. N Engl J Med 1993;329:383389.Google Scholar
4. Weaver, WB, Eisenberg, MS, Martin, JS, et al. : Myocardial infarction triage and intervention project—Phase I: Patient characteristics and feasibility of prehospital initiation of thrombolytic therapy. J Am Coll Cardiol 1990;15:925931.CrossRefGoogle ScholarPubMed
5. Aufderheide, TP, Keelan, MH, Hendley, GE, et al. : Milwaukee prehospital chest pain project—Phase I: Feasibility and accuracy of prehospital thrombolytic candidate selection. Am J Cardiol 1992;3:4146.Google Scholar
6. Gibler, WB, Kereiakes, DJ, Dean, EN, et al. : Prehospital diagnosis and treatment of acute myocardial infarction: north-south perspective. Am Heart J 1991;121:111.CrossRefGoogle ScholarPubMed
7. Bouten, MJM, Simoons, ML, Hartman, JAM, et al. : Prehospital thrombolysis with alteplase (rt-PA) in acute myocardial infarction. Eur Heart J 1992;13:925931.CrossRefGoogle ScholarPubMed
8. Risenfors, M, Gustavsson, G, Ekstrom, L, et al. : Prehospital thrombolysis in suspected acute myocardial infarction: Results from the TEA-HAT Study. J Intern Med 1991;229 (Suppl 1):401407.Google Scholar
9. Weiss, A, Fine, D, Applebaum, D, et al. : Prehospital coronary thrombolysis, a new strategy in acute myocardial infarction. Chest 1987;92:124128.CrossRefGoogle ScholarPubMed
10. Bossaert, L, Demey, H, Colemont, L, et al. : Prehospital thrombolytic treatment of acute myocardial infarction with anisoylated plasminogen streptokinase activator complex. Crit Care Med 1988;16:823830.CrossRefGoogle Scholar
11. Castaigne, A, Herve, C, Duval-Moulin, A, et al. : Prehospital use of APSAC: Results of a placebo-controlled study. Am J Cardiol 1989;64:30A33A.CrossRefGoogle ScholarPubMed
12. Schofer, J, Buttner, J, Geng, G, et al. : Pre-hospital thrombolysis in acute myocardial infarction. Am J Cardiol 1990;66:14291433.CrossRefGoogle Scholar
13. Aufderheide, TP, Haselow, WC, Hendley, GE, et al. : Feasibility of prehospital r-TPA therapy in chest pain patients. Ann Emerg Med 1992;21:379383.CrossRefGoogle ScholarPubMed
14. Karagounis, L, Ipsen, SK, Jessop, MR, et al. : Impact of field-transmitted electrocardiography on time to in-hospital thrombolytic therapy in acute myocardial infarction. Am J Cardiol 1990;66:786791.CrossRefGoogle ScholarPubMed
15. Aufderheide, TP, Lawrence, SW, Hall, KN, Otto, LA: Pre-hospital 12-lead electrocardiograms reduce hospital-based time to treatment in thrombolytic candidates. Acad Emerg Med 1994;1:A13–A14. Abstract.Google Scholar
16. Kereiakes, DJ, Gibler, WB, Martin, LH, et al. : Relative importance of emergency medical system transport and the prehospital electrocardiogram on reducing hospital time delay to therapy for acute myocardial infarction: A preliminary report from the Cincinnati Heart Project. Am Heart J 1992:123:835840.CrossRefGoogle ScholarPubMed
17. Aufderheide, TP, Hendley, GE, Thakur, RK, et al. : The diagnostic impact of prehospital 12-lead electrocardiography. Ann Emerg Med 1990;19:12801287.CrossRefGoogle Scholar
18. Aufderheide, TP, Hendley, GE, Woo, J, et al. : A prospective evaluation of prehospital 12-lead ECG application in chest pain patients. J Electrocardiol 1992:24 (Suppl):813.CrossRefGoogle ScholarPubMed
19. White, RD: Prehospital 12-lead ECG. Ann Emerg Med 1992;21:586. Letter.CrossRefGoogle ScholarPubMed
20. Aufderheide, TP: Prehospital 12-lead electrocardiography and evaluation of the patient with chest pain. In Gibler, WB, Aufderheide, TP, (eds): Emergency Cardiac Care, St. Louis, 1994, Mosby, pp 3865.Google Scholar
21. Kereiakes, DJ, Aufderheide, TP, Martin, LH: A team approach to early thrombolysis for AMI patients. A monograph supported by an educational grant from Genentech, Inc., San Francisco, 1992.Google Scholar
22. Grim, P, Feldman, T, Childers, RW: Evaluation of patients for the need of thrombolytic therapy in the prehospital setting. Ann Emerg Med 1989;18:483488.CrossRefGoogle ScholarPubMed
23. Kereiakes, DJ, Weaver, WD, Anderson, JCL, et al. : Time delays in the diagnosis and treatment of acute myocardial infarction: A tale of eight cities. Report from the Prehospital Study Group and the Cincinnati Heart Project. Am Heart J 1990;120:773780.CrossRefGoogle ScholarPubMed
24. Otto, LA, Aufderheide, TP: Evaluation of ST segment elevation criteria for the prehospital electrocardiographic diagnosis of acute myocardial infarction. Ann Emerg Med 1994;23:1724.CrossRefGoogle Scholar
25. Kudenchuk, PJ, Ho, MT, Weaver, WD, et al. : Accuracy of computer-interpreted electrocardiography in selecting patients for thrombolytic therapy. J Am Coll Cardiol 1991;17:14861491.CrossRefGoogle ScholarPubMed
26. Grijseels, EWM, Deckers, JW, Hoes, AW, et al. : Pre-hospital triage of patients with suspected myocardial infarction: Evaluation of previously developed algorithms and new proposals. Eur Heart J 1995;16:325332.CrossRefGoogle ScholarPubMed
27. Aufderheide, TP, Rowlandson, I, Laurence, SW, et al. : Test of acute cardiac ischemia time-insensitive predictive instruments (ACI-TIPI) for prehospital use. Ann Emerg Med 1996;27:193198.CrossRefGoogle Scholar