Framework for assessment of the 12 lead ECG in transient loss of consciousness

Cardiac arrhythmia affects more than 700 000 people in England and is consistently included in the top ten reasons for admission to hospital, placing a significant strain on emergency department time and bed availability (Department of Health (DH), 2005). Following the introduction of pre-hospital thrombolysis as part of the National Service Framework (NSF) for coronary heart disease (CHD), the acquisition and interpretation of 12 lead ECGs has become a routine part of UK paramedic practice. Although training models have varied nationally, the main focus has been on the use of 12 lead electrocardiographs (ECGs) to identify changes associated with ST elevation myocardial infarction (STEMI) in order to facilitate early reperfusion measures.

The subsequent publication of an addendum to the NSF for CHD in the form of Chapter 8 Arrhythmias focussed attention on the needs of patients presenting with arrhythmias (DH, 2005). The publication detailed a number of quality requirements relating to patient support, diagnosis and treatment, and sudden cardiac death. The need for a 12 lead ECG to be recorded and archived for any patient presenting with a suspected arrhythmia was emphasised, alongside recommendations relating to arrhythmia education for clinical staff and improving awareness of conditions that may lead to sudden cardiac death (DH, 2005). More recently, National Institute for Clinical Excellence (NICE) guidance relating to transient loss of consciousness (T-LOC) has again emphasised the importance of the routine acquisition and interpretation of the 12 lead ECG as a fundamental part of assessment, diagnosis, risk stratification and onward referral in this patient group (NICE, 2010).