title: On-line telemetry: prospective assessment of accuracy in an all-volunteer emergency medical service system.
abstract: OBJECTIVE
  To evaluate the need for on-line telemetry control in an all-volunteer, predominantly advanced emergency medical technician (A-EMT) ambulance system.
  
  
  METHODS
  Emergency medical service (EMS) advanced life support (ALS) providers were asked to transmit the ECG rhythms of monitored patients over a six-month period in 1993. The ECG rhythm interpretations of volunteer EMS personnel were compared with those of the on-line medical control physician. All discordant readings were reviewed by a panel of physicians to decide whether the misdiagnosis would have resulted in treatment aberrations had transmission been unavailable.
  
  
  RESULTS
  Patients were monitored and rhythms were transmitted in 1,825 cases. 1,642 of 1,825 rhythms were correctly interpreted by the EMS providers (90%; 95% CI 89-91%). The accuracy of the EMS providers was dependent on the patient's rhythm (chi-square, p < 0.00001), the chief complaint (chi-square, p = 0.0001), and the provider's level of training (chi-square, p = 0.02). Correct ECG rhythm interpretations were more common when the out-of-hospital interpretation was sinus rhythm (95%), ventricular fibrillation (87%), paced rhythm (94%), or agonal rhythm (96%). The EMS providers were frequently incorrect when the out-of-hospital rhythm interpretation was atrial fibrillation/flutter (71%), supraventricular tachycardia (46%), ventricular tachycardia (59%), or atrioventricular block (50%). Of the 183 discordant cases, 124 (68%) involved missing a diagnosis of, or incorrectly diagnosing, atrial fibrillation/flutter. Review of the discordant readings identified 11 cases that could have resulted in treatment errors had the rhythms not been transmitted, one of which might have resulted in an adverse outcome.
  
  
  CONCLUSIONS
  In this all-volunteer, predominantly A-EMT ALS system, patients with a field interpretation of a sinus rhythm do not require ECG rhythm transmission. Field interpretations of atrial fibrillation/flutter, supraventricular tachycardia, ventricular tachycardia, and atrioventricular blocks are frequently incorrect and should continue to be transmitted.
authors.affiliation: Department of Emergency Medicine, University Medical Center, Stony Brook, NY 11794-7400, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Hollander
authors.forename: R
authors.initials: R
authors.lastname: Delagi
authors.forename: J
authors.initials: J
authors.lastname: Sciammarella
authors.forename: P
authors.initials: P
authors.lastname: Viccellio
authors.forename: J
authors.initials: J
authors.lastname: Ortiz
authors.forename: M C
authors.initials: MC
authors.lastname: Henry
mesh_terms: D016009:Chi-Square Distribution; D002983:Clinical Competence; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000592:standards*; D004634:Emergency Medical Technicians / Q000592:standards*; D006331:Heart Diseases / Q000175:diagnosis*; D006801:Humans; D011361:Professional Competence; D011446:Prospective Studies; D013686:Telemetry