Here's an interesting case that illustrates the value of the prehospital 12 lead ECG.
A 66 year old male became suddenly ill while playing tennis. Bystanders state that he struck the ball with his racket, staggered a few steps, placed his hand over his chest, and sat down on the tennis court.
9-1-1 was contacted immediately.
Past medical history is significant for hypertension, hyperlipidemia, and a "previous episode of chest pain" for which the patient carries SL NTG which he rarely takes PRN for chest discomfort.
A paramedic from out-of-town was present on scene and gave the patient his own NTG.
On EMS arrival, the patient appears acutely ill. He is diaphoretic and weak, complaining of chest pain.
Vital signs are assessed.
SpO2: 98 on RA
The cardiac monitor is attached.
Even in monitor mode, you can see ugly looking ST segment elevation in lead III with reciprocal ST segment depression in lead I.
A 12 lead ECG is captured.
This removes all doubt. The ECG shows acute inferior STEMI. There are Q waves in leads III and aVF with ST segment elevation. There are downsloping ST segments in leads I and aVL which represent reciprocal changes.
The 12 lead ECG was transmitted to the local receiving PCI hospital.
The paramedic in charge of the call (good job Tina H.) placed the patient on oxygen, had the patient chew up 4 baby aspirin, started an IV, gave the patient a fluid bolus, and administered SL NTG and 5 mg of morphine.
Look at the next 12 lead ECG captured less than 10 minutes later.
Where is the ST segment elevation? It's gone. The ECG is now non-diagnositc.
If not for the prehospital 12 lead ECG, there's no telling how long this patient would have sat in the emergency department, infarcting away.
Instead, the patient had a 39 minute door-to-balloon (D2B) time.
If you know any old-school paramedics, medical directors, or administrators who care about patients but still aren't sure prehospital 12 lead ECGs are necessary, be sure to share this case with them!