The Need for Paramedic ECG Interpretation Debate

The importance of paramedic ECG or IKG (in the US) interpretation is debated amongst clinical practitioners, doctors, paramedics, ambulance officers, EMTs and other members of the health community. There are multiple arguments that promote ambulance paramedics’ being capable and regularly thoroughly interpreting ECGs and similiarly many arguments stating that paramedics only need to know those ECG rhythyms that they can actually do something about. These are the arguments that have been debated over the years… I’ll let you decide:

1. There is the argument that the only real ECG rhythyms that paramedics need to interpret and identify are those, which paramedics can actually do something about, such as ventricular fibrilation (VF), ventricular tachycardiac (VT), and those which there is little that can be done for such as assystole. More in depth analysis of ECG rhythyms such as 1st, 2nd or 3rd degree heart blocks, wolf-parkinson white syndrome, etc, although interesting and useful to know, will not affect the paramedic’s treatment of the patient in the pre-hospital care setting, and the delay while the paramedic attempts to identify the rhythym may be counter-productive to the patient’s health outcome.

2. Other other side of the debate, one may argue that the better the paramedic’s sound knowledge base, and diagnostic abilities, the better the treatment. Although the paramedic may not be able to treat atrial fibrilation, or a 2nd degree type I heart block, identifying it may allow the paramedic to recognise, or rationalise the patient’s other physiological findings, in order to differ treatment. For example, the paramedic may rationalise that the patient has a low blood preasure because the patient has AF and the heart is not fully filling therefore more intraveneous fluid will not actually help the situation. Furthermore, if the paramedic recognises that the patient is in a 3rd degree heartblock (where there is no correlation between the SA node firing and the Ventricals contracting) the paramedic will realise that administering atropine to increase the pule rate will not actually work.

3. Another concept has been proposed more recently as the term or role of a paramedic has changed to encompass much more community health over emergency health, and this is that by having 12 lead ECGs and a thorough understanding of the electrophysiology, a paramedic is more likely to be able to safely rule out cardiac problems, and may identify patients who do not need to go to hospital.

4. It has also been argued that by having 12 lead ECGs in the pre-hospital care setting, paramedics can realistic confirm an acute myocardial infarction (heart attack) and in doing so treat it with thrombolytics in the pre-hospital setting, therefore reducing treatment times, and myocardial damage. Although, where paramedics are not able to administer thrombolytics in an Ambulance, the increased scene time required to complete an accurate 12 ECG may be counter productive to the patient’s health outcome.