title: The prehospital 12-lead electrocardiogram: impact on management of the out-of-hospital acute coronary syndrome patient.
abstract: The electrocardiogram (ECG), when applied in the prehospital setting, has a significant effect on the patient with chest pain. The potential effect on the patient includes both diagnostic and therapeutic issues, including the diagnosis of acute myocardial infarction (AMI) and the indication for thrombolysis. The prehospital ECG may also detect an ischemic change that has resolved with treatment delivered by emergency medical services (EMS) prior to the patient's arrival in the emergency department (ED). Perhaps the most significant issue in the management of chest-pain patients involves the effect of the out-of-hospital ECG on the ED-based delivery of reperfusion therapy, such as thrombolysis. In AMI patients with ST-segment elevations, it has been conclusively demonstrated that information obtained from the prehospital ECG reduces the time to hospital-based reperfusion treatment. Importantly, these benefits are encountered with little increase in EMS resource use or on-scene time.
authors.affiliation: Department of Emergency Medicine, University of Virginia, Charlottesville, Virginia 22908, USA.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Ferguson
authors.forename: William J
authors.initials: WJ
authors.lastname: Brady
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Perron
authors.forename: Nicole D
authors.initials: ND
authors.lastname: Kielar
authors.forename: John P
authors.initials: JP
authors.lastname: Benner
authors.forename: Scott B
authors.initials: SB
authors.lastname: Currance
authors.forename: Sabina
authors.initials: S
authors.lastname: Braithwaite
authors.forename: Tom P
authors.initials: TP
authors.lastname: Aufderheide
mesh_terms: D000368:Aged; D040421:Cell Phone; D002637:Chest Pain / Q000209:etiology; D003327:Coronary Disease / Q000175:diagnosis; D004562:Electrocardiography / Q000295:instrumentation; D004566:Electrodes; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D015912:Thrombolytic Therapy