Beyond Basic Training

There is ongoing debate about the benefits of transmitting 12-lead EKGs to receiving destinations, especially if paramedics are on scene. Proponents of transmission, as we are, speak to the benefit of multiple clinicians reviewing EKGs, diminishing the chances of subtle STEMIs being missed. Saddling the paramedic with doing all of the identified tasks in parallel with obtaining the 12-lead EKG can prove distracting at best and dangerous at worst when vital information is missed. Trying to avoid parallel tasks and doing the same things in serial order also poses difficulties in time efficiencies.

Regardless of EMS system type or care capability, when EMT-Basics are incorporating 12-lead EKG abilities in their scope of practice, it should be clearly included in relevant treatment protocols or guidelines. In states that permit EMT-Basics to acquire and transmit 12-lead EKGs, formal training and continuing education should be conducted as part of an organized credentialing process. In areas that currently restrict EMT-Basics from even obtaining 12-lead EKGs, organized advocacy efforts for changing the scope of allowable practice can take advantage of an expanding body of medical literature supporting early and aggressive use of 12-leads by all levels of EMS professionals.

David S. Howerton, NREMT-P, is director of clinical affairs for the Western Division of the Emergency Medical Services Authority (EMSA), the EMS system serving metropolitan Oklahoma City and Tulsa, OK.

Jim O. Winham, RN, BSN, NREMT-P, is director of clinical affairs for EMSA’s Eastern Division.

T.J. Reginald, NREMT-P, is director of research and clinical standards development in EMSA’s Office of the Medical Director.

Jeffrey M. Goodloe, MD, NREMT-P, FACEP, is medical director for the Medical Control Board that oversees the EMS system serving metropolitan Oklahoma City and Tulsa, as well as an associate professor of emergency medicine at the University of Oklahoma School of Community Medicine.