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Paramedic electrocardiogram interpretation in acute coronary syndrome

02 December 2023
Volume 15 · Issue 12



The paramedic use of electrocardiogram (ECG) is the gold standard for prehospital identification of acute myocardial infarction. Following an extension to their scope of practice, all paramedics have the capability to identify an ST-elevation myocardial infarction (STEMI). However, there have been no investigations into paramedic ECG interpretation.


This study aimed to investigate paramedic accuracy regarding ECG interpretation and compare findings with international literature.


Anonymous participants were voluntarily recruited to interpret 12 ECGs. A literature review was undertaken to compare results with previous studies.


Paramedics correctly identified the ECGs with a mean score of 63%. Accuracy in ECG interpretation increased with a higher educational background and specialist training. Postgraduate mean accuracy was 83.33%, with specialist accuracy at 83.53%.


Further education and research into interpreting difficult ECGs is necessary. Australian services may consider the implementation of modified cardiac protocols to include suspected non-STEMI.

The identification and treatment of acute coronary syndrome (ACS) is a priority for Australian paramedics. ACS refers to a group of conditions that affect coronary blood flow and includes unstable angina and acute myocardial infarction (MI), which is diagnosed as either ST-elevation MI (STEMI) or non-ST-elevation MI (NSTEMI) (Bhatt et al, 2022). The acquisition and interpretation of a 12-lead ECG is considered the gold standard for early identification and management of ACS in the prehospital setting (Prihatiningsih and Hutton 2018). This is associated with significant reduction in time to definitive treatment without adversely increasing prehospital scene times (Mobrad 2020; Alrumayh et al, 2022). Where STEMI is misdiagnosed, mortality increases from 2% to 25.9% (Dee et al, 2022).

Recent advances in ECG interpretation have led to the finding that up to 28% of NSTEMIs present with a complete coronary occlusion and may be detected on an ECG (McLaren et al, 2022).

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