12-lead ECG acquisition, transmission & interpretation in the prehospital environment can be performed only by EMT/AEMT/Paramedics &the reading by AEMT/Paramedics.

STANDING ORDERS:-

Obtain 12-lead ECG with baseline vitals within 10 minutes for potential ACS if available and practical and transmit per local guidelines.

INDICATIONS:-

• Congestive Heart Failure/Pulmonary Edema
• Dysrhythmias, palpitations
• Suspected Acute Coronary Syndrome (chest, jaw, arm, or epigastric discomfort, diaphoresis weakness)
• Syncope
• Shortness of breath

PROCEDURE:-

• Prepare ECG Monitor and connect cable with electrodes.
• Properly position the patient (supine or semi-reclined).
• Enter patient information (e.g. age, gender) into monitor.
• Prep chest as necessary, (e.g. hair removal, skin prep pads).
• Apply chest and extremity leads using recommended landmarks:
  • RA - Right arm or shoulder.
  • LA - Left arm or shoulder.
  • RL - Right leg or hip.
  • LL - Left leg or hip.
  • V1 - 4TH intercostal space at the right sternal border.
  • V2 - 4TH intercostal space at the left sternal border.
  • V3 - Directly between V2 and V4.
  • V4 - 5TH intercostal space midclavicular line.
  • V5 - Level with V4 at left anterior axillary line.
  • V6 - Level with V5 at left midaxillary line.
• Instruct patient to remain still.
• Obtain the 12-lead ECG, read interpretation, and transmit if possible.
• If the interpretation reads, ***Acute MI*** or ***Acute MI Suspected***, or other similar message, transport patient to the most appropriate.
• facility in accordance with local MI guidelines/agreements and notify receiving facility of a “MI ALERT.”
• If the ECG interprets to be an acute ST-elevation myocardial infarction (MI), transport patient to the most appropriate facility in accordance with local MI guidelines/agreements and notify receiving facility of a “MI ALERT.”
• For patients with continued symptoms consistent with acute coronary syndrome, perform repeat ECGs during transport to evaluate for evolving MI.
• Copies of 12-lead ECG labeled with the patient’s name and date of birth should be left with the receiving hospital and incorporated into the patient’s SIREN record.