I’ve been giving a lot of thought lately to paramedic education and the problem of 12-lead ECG interpretation.
Specifically, the reasons why paramedics aren’t taught to actually read a 12-lead ECG and are instead given a crash course in “STEMI recognition” which does not prepare the student to differentiate between the ST-elevation of acute STEMI and other causes of ST-elevation.
This TED Talk by Dan Meyer about high school math education struck a chord with me. I highly recommend the entire talk, but the most relevant part for this discussion starts at 01:50.
Here’s the part that really resonated with me:
“David Milch, creator of Deadwood and other amazing TV shows […] swore off creating contemporary drama — shows set in the present day — because he saw that when people filled their minds with 4 hours a day of, for example, 2 1/2 Men, it shapes the neuro-pathways in such a way that they expect simple problems. He called it an “impatience with irresolution”. You’re impatient with things that don’t resolve quickly. You expect sitcom-sized problems that wrap up in 22 minutes, 3 commercial breaks, and a laugh track. I’ll put it to all of you — what you already know. No problem worth solving is that simple.”
Doesn’t that exactly describe the paramedic approach to 12-lead ECG interpretation (e.g., EKGs for Dummies, 12-Leads Made Easy, Rapid STEMI ID, etc.)?
Just the “need to know” information without all the difficulty of axis determination, bundle branch blocks, electrolyte derangements, differential diagnosis of tachycardias, primary and secondary ST-T wave abnormalities, identifying acute STEMI in the presence of STE-mimics, and other things that we have no patience for because we can’t learn it in 22 minutes.
As if we can jump straight to the finish line and enjoy the fruits of victory without ever preparing for the race.
The problem is compounded by policy makers who “don’t know what they don’t know” (thank you Don Rumsfeld). They consider it a foregone conclusion that comprehensive 12-lead ECG knowledge is not practical for paramedics.