Bagai A, Al-Khalidi HR, Sherwood MW Regional systems of care demonstration project: MISSION: Lifeline STEMI Systems Accelerator: design and methodology. Am Heart J. 2014; 167:(1)15-21.e3

Batt A, Buick JE. The evolution of the paramedic. Can Paramed. 2015; 38:22-25

Batt AM. Welcome to the Irish Journal of Paramedicine. Ir J Paramed. 2016; 1:(1)

Brooks J, McCluskey S, Turley E, King N. The utility of template analysis in qualitative psychology research. Qual Res Psychol. 2015; 12:(2)202-222

Caffrey SM, Barnes LC, Olvera DJ. Joint position statement on degree requirements for paramedics. Prehosp Emerg Care. 2019; 23:(3)434-437

Cantor WJ, Hoogeveen P, Robert A Prehospital diagnosis and triage of ST-elevation myocardial infarction by paramedics without advanced care training. Am Heart J. 2012; 164:(2)201-206

Cheskes S, Turner L, Foggett R 2011. Paramedic contact to balloon in less than 90 minutes: a successful strategy for ST-segment elevation myocardial infarction bypass to primary percutaneous coronary intervention in a Canadian emergency medical system. Prehosp Emerg Care. 2011; 15:(4)490-498

Cummins NM, Garavan C, Dixon M, Landymore E, Mulligan N, O'Donnell C. The Advanced Paramedic Clinical Activity Study (APCAS): an insight into the work of advanced paramedics in the mid-west of Ireland. Ir J Med Sci. 2013; 182:(3)469-475

Curran V, Fleet L, Simmons K, Ravalia M, Snow P. Exploratory study of rural physicians' self-directed learning experiences in a digital Age. J Contin Educ Health Prof. 2016; 36:(4)284-289

Integrated healthcare in Ireland—a critical analysis and a way forward. 2013. https// (accessed 20 November 2021)

Daudelin DH, Sayah AJ, Kwong M Improving use of prehospital 12-lead ECG for early identification and treatment of acute coronary syndrome and ST-elevation myocardial infarction. Circ Cardiovasc Qual Outcomes. 2010; 3:(3)316-323

Davis M, Lewell M, McLeod S, Dukelow A. A prospective evaluation of the utility of the prehospital 12-lead electrocardiogram to change patient management in the emergency department. Prehosp Emerg Care. 2014; 18:(1)9-14

Donaghy J. Higher education for paramedics—why?. J Paramed Pract. 2018; 1:(1)31-35

Funder JL, Ross L, Ryan S. How effective are paramedics at interpreting ECGs in order to recognize STEMI? A systematic review. Australas J Paramed. 2020; 2009. https// (accessed 20 November 2021)

Hale P, Lowe R, Seamon JP, Jenkins JJ. Paramedic electrocardiogram and rhythm identification: a convenient training device. Prehospital Disaster Med. 2011; 26:(5)342-345

Hou X-Y, Rego J, Service M. Review article: paramedic education opportunities and challenges in Australia. Emerg Med Australas. 2013; 25:(2)114-119

Ibanez B, James S, Agewall S 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018; 39:(2)119-177

Jennings S, Daly K, Cavanagh B, O'Donnell C. Standardising care for heart attack (STEMI) patients, Ireland. Int J Integr Care. 2017; 17:(3)

Knowles MS. Andragogy, not pedagogy. Adult Leadersh. 1958; 16:(10)350-352

Knox S, Cullen W, Dunne C. Continuous professional competence (CPC) for Irish paramedics and advanced paramedics: a national study. BMC Med Educ. 2014; 14:(1)

Le May MR, Dionne R, Maloney J, Poirier P. The role of paramedics in a primary PCI program for ST-elevation myocardial infarction. Prog Cardiovasc Dis. 2010; 53:(3)183-187

Maguire BJ, O'Meara P, Newton A. 2016. Toward an international paramedic research agenda. Ir J Paramed. 2016; 1:(2)

Mamary E, Charles P. Promoting self-directed learning for continuing medical education. Med Teach. 2003; 25:(2)188-190

May MRL, Dionne R, Maloney J Diagnostic performance and potential clinical impact of advanced care paramedic interpretation of ST-segment elevation myocardial infarction in the field. Can J Emerg Med. 2006; 8:(6)401-407

McCutcheon K, Lohan M, Traynor M, Martin D. A systematic review evaluating the impact of online or blended learning vs face-to-face learning of clinical skills in undergraduate nurse education. J Adv Nurs. 2015; 71:(2)255-270

Mencl F, Wilber S, Frey J, Zalewski J, Maiers JF, Bhalla MC. Paramedic ability to recognize ST-segment elevation myocardial infarction on prehospital electrocardiograms. Prehosp Emerg Care. 2013; 17:(2)203-210

Meyers HP, Smith SW. Prospective, real-world evidence showing the gap between ST elevation myocardial infarction (STEMI) and occlusion MI (OMI). Int J Cardiol. 2019; 293:48-49

Millar-Craig MW, Joy AV, Adamowicz M, Furber R, Thomas B. Reduction in treatment delay by paramedic ECG diagnosis of myocardial infarction with direct CCU admission. Heart. 1997; 78:(5)456-461

Mortari L. Reflectivity in research practice: an overview of different perspectives. Int J Qual Methods. 2015; 14:(5)

Munger R. Evolution of the emergency medical services profession: a case study of EMS run reports. Tech Commun Q. 2000; 9:(3)329-346

Nam J, Caners K, Bowen JM, Welsford M, O'Reilly D. Systematic review and meta-analysis of the benefits of out-of-hospital 12-lead ECG and advance notification in ST-segment elevation myocardial infarction patients. Ann Emerg Med. 2014; 64:(2)176-186.e9

National Ambulance Service. Human resources—workforce plan 2016–2020. 2015. https// (accessed 20 November 2021)

Nilsson M, Östergren J, Fors U Does individual learning styles influence the choice to use a web-based ECG learning programme in a blended learning setting?. BMC Med Educ. 2012; 12:(1)

National Ambulance Service (NAS) Procedure. Appropriate hospital access for ST elevation myocardial infarction patients. 2012. https// (accessed 20 November 2021)

O'Meara P, Tourle V, Stirling C, Walker J, Pedler D. Extending the paramedic role in rural Australia: a story of flexibility and innovation. Rural Remote Health. 2012; 12:(2)

Pre-Hospital Emergency Care Council. A view of pre-hospital emergency care in Ireland. 2008. https//

Quinn T, Johnsen S, Gale CP Effects of prehospital 12-lead ECG on processes of care and mortality in acute coronary syndrome: a linked cohort study from the Myocardial Ischaemia National Audit Project. Heart. 2014; 100:(12)944-950

Roffi M, Patrono C, Collet J-P 2016. 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016; 37:(3)267-315

Schifferdecker KE, Reed VA. Using mixed methods research in medical education: basic guidelines for researchers. Med Educ. 2009; 43:(7)637-644

Smith G. The challenges of paramedic education in the new millennium: chasing the evolution of paramedic practice. Australas J Paramed. 2017; 14:(4)

Smith JA, Shinebourne P. Interpretative phenomenological analysis. In: Cooper H, Camic PM, Long DL, Panter AT, Rindskopf D, Sher KJ (eds). Washington (DC): American Psychological Association; 2021

Squire BT, Tamayo-Sarver JH, Rashi P, Koenig W, Niemann JT. Effect of prehospital cardiac catheterization lab activation on door-to-balloon time, mortality, and false-positive activation. Prehosp Emerg Care. 2014; 18:(1)1-8

Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007; 19:(6)349-357

Tubaro M, Danchin N, Goldstein P Pre-hospital treatment of STEMI patients. A scientific statement of the Working Group Acute Cardiac Care of the European Society of Cardiology. Acute Card Care. 2011; 13:(2)56-67

Vertesi L. The paramedic ambulance: a Canadian experience. Can Med Assoc J. 1978; 119:(1)25-29

Widimský P, Rokyta R, Št׳ásek J, Bělohlávek J, Červinka P, Kala P. Acute coronary syndromes with ongoing myocardial ischemia (ACS with OMI) versus acute coronary syndromes without ongoing ischemia (ACS without OMI): the new classification of acute coronary syndromes should replace old classification based on ST segment elevation presence or absence—expert consensus statement of the Czech Society of Cardiology. Cor Vasa. 2013; 55:(3)e225-e227

Williams B, Onsman A, Brown T. Is the Australian paramedic discipline a profession? A national perspective. Int Paramed Pract. 2012; 2:(3)77-84

Beyond STEMI: paramedics' views on how to improve their ability to interpret ECGs

02 December 2021
Volume 13 · Issue 12



Internationally, the paramedic scope of practice is developing. Bypassing emergency departments in favour of direct access to primary percutaneous coronary intervention laboratories has been limited largely to cases of ST-elevation myocardial infarction and new-onset left bundle branch block, but updates to international guidelines suggest that enhancing paramedics' skills in interpreting electrocardiograms (ECGs) and widening the bypass criteria could be beneficial.


The aim of the study is to explore paramedics' views on ways to improve their ECG interpretation abilities.


A two-arm design was used with an online questionnaire (quantitative) and one-to-one interviews (qualitative). The questionnaire results were used to inform the interview guide.


One hundred and eighteen paramedics completed the survey, and 11 took part in interviews. The major themes identified from the template analysis of the interviews were ‘a profession in transition’, ‘lagging professional development’ and ‘supporting the frontline’. Self-directed learning resources before, during and after action were proposed.


Paramedicine is evolving in Ireland and practitioners have reported undertaking self-directed learning activities. The resulting heterogeneity in skills such as ECG interpretation, and perceived barriers to education, can cause feelings of vulnerability within the profession. Supporting the frontline by introducing some Group-Orchestrated Self-Directed Learning resources could empower practitioners and contribute to the evolution of prehospital care in Ireland.

Paramedic practice around the world is rapidly evolving (Vertesi, 1978; Munger, 2000; O'Meara et al, 2012; Batt, 2016), demonstrated by the international transition towards third-level education (Donaghy, 2008; Hou et al, 2013; Maguire et al, 2016; Caffrey et al, 2019).

In Ireland, healthcare has been moving towards a collaborative, integrated system (Darker, 2013), exemplified by the management of cardiovascular emergencies, which requires cooperation between prehospital emergency medical services (EMS), emergency departments, cardiology services and primary percutaneous coronary intervention (PPCI) centres (Tubaro et al, 2011; Bagai et al, 2014; Jennings et al, 2017).

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