About EMS 12-Lead

Editor-in-ChiefTom Bouthillet - Editor-in-Chief

Tom Bouthillet is a Fire Captain / Paramedic, developer of the 12-Lead ECG Challenge app (Apple, Android, Amazon, Web), a member of the Editorial Advisory Board of EMS World, a member of the Editorial Board of JEMS, a columnist for EMS1.com, an EMS 10 Award recipient, co-founder of the EKG Club, co-founder of NeuroEMS, and founder of the Resuscitation group. He has taught nationally in the Critical Care Transport (CCEMT-P) program out of UMBC and his writings have been referenced in the American Heart Journal, the Journal of the American College of Cardiology: Cardiovascular Interventions and the EP Lab Digest. All opinions expressed by Tom are his own and not the opinion of his employer.

Contact: Email, LinkedIn, Twitter, Facebook, Google+


David Baumrind - Associate Editor

Senior Editor

David Baumrind is a Paramedic in Eastern Long Island, New York where he is the STEMI/Cardiac Arrest coordinator for his department. David has spent the past several years studying 12 Lead ECG’s and found the EMS 12 Lead blog early in his studies. David has been an active reader and frequent contributor, and began on the team as an Associate Editor in March 2010.

Contact: Email, Facebook



Christopher Watford - Associate Editor

Senior Editor

Christopher Watford is a Lieutenant / Paramedic and Board Member at Leland Volunteer Fire/Rescue Department (Leland, NC). At his day job, Christopher is a Lead Software Engineer with GE’s Global Nuclear Fuel – Americas and a Captain on their industrial fire brigade (Wilmington, NC). He also works part-time as a Paramedic for New Hanover Regional EMS (Wilmington, NC). Christopher found the EMS 12 Lead blog during paramedic school, has been an active reader and contributor, and began on the team as an Associate Editor in March 2010. All opinions expressed by Christopher are his own, and do not reflect the opinions of his employers.

Contact: Email, LinkedInFacebook


Associate EditorVinceD

Vince DiGiulio is an EMT-Critical Care in Binghamton, NY and has been an active reader and contributor to this blog ever since he was an EMT-Basic. Unlike most of the team he works almost exclusively inside the emergency department, affording him a slightly different experience when it comes to the evaluation, management, and disposition of acute-care patients. He also maintains a personal emergency medicine education blog called The Medial Approach to EM, along with several side-blogs linked there.

Contact: Email, Google+Twitter



Associate Editorivanr

Ivan J. Rios is a Cardiology and Electrophysiology enthusiast from Orlando, Fl and a loyal EMS12lead.com follower for over 4 years. He is a Critical Care Paramedic, currently working as a Paramedic/Field Training Officer for Sumter County, Fl, as well as an EMT and Paramedic Instructor at a local school, First Response Training Group. He has a great passion for Emergency Medicine and music, as an Acoustic Singer/Songwriter artist, know as Ivan J. Nash, by his local following.

Contact: Email, Google+



Associate EditorME-at the lake

Brooks Walsh is a board-certified emergency physician working in Connecticut. He studied the philosophy of physics in college (Bell’s  Theorem anyone?), and attempted a masters-degree program in pure mathematics. He found far more success in an EMT-B class, however,and spent the next eight years in EMS (five of those as a paramedic) working for private, volunteer, and hospital-based EMS agencies. He once led a traditional 5.10 route in New Hampshire (since downgraded to 5.9+ … ), has summited Denali, can often correctly use the subjunctive in Spanish, finished a marathon in 4:37, has a 2K erg time of 6:46, and is never, ever, sick at sea.

Contact: Email


  • L says:

    I have come across your web site many times and find it to be an awesome resource. Thank you and keep it up! Since HIPAA, I have found it difficult to follow up on patient outcomes-hence my learning was limited in that respect.
    Thank you again.

  • You’re welcome, L!

  • Jesse says:

    Just an off the wall question kinda related to this topic. I recently had an anterior MI new and evolving en route to the ED. Anyways everything went great cath lab and all the bells and whistles but my question was the Doc called the shape of this guys st segment a sign of some sort like a name of some famous doctor or something I just cant remember what he said but I know it has to do with the type and shape being concave or convex or a specific type of st segment maybe only or usually found in anterior wall MIs. I cant remember what he called it and I have heard it before. Anyone can help me out?

  • Christopher says:

    Perhaps Wellen’s T-waves?

  • Jesse says:

    Yes Wellen’s is correct. That what he said. You know a good site I can learn more about this or do you know a little bout it

  • Christopher says:

    Dr. Smith’s ECG Blog has at least one case featuring the evolution of Wellen’s T-waves. They are typically deeply inverted, symmetrical T-waves or biphasic T-waves in V2-V3, without the loss of R waves in those same leads. Often a sign of proximal LAD stenosis. Along with de Winter and Brugada, it is a shape of ST/T waves that you should become familiar with in the long term.

  • Leevy says:

    I was looking at your diagram for 12 leads placement..I counted only 10 sites..where are the other 2 electrodes or is it only 10 sites?

  • John says:

    I had a question.  I am doing a reasearch on time to prehospital 12 lead and I was wondering if you have studies that you are aware of that may be helpful.  I have looked at the usual places, pubmed, etc but have not found much.  Anything you can share would be appreciated.

  • Ryan says:

    10 sites are normal. These 'sites' to name them properly are called electrodes. An ECG Lead is made up by combining two of these electrodes.
    Basically the three electrodes placed on the right arm (RA), left arm (LA) and left leg (LL) are combined to make 3 lead views of the heart (leads I, II and III). The ECG machine then augments them to generate an additional 3 views (aVR, aVF and aVL), thus these three electrodes generate a total of 6 lead views of the heat. The chest leads V1 – V6 make up the other 6 views giving us a total of 12 leads from 9 electrode placements.
    The electrode on the RL is used only as an earth reference point.
    If you are interested to learn more you should do some reading on Einthoven's Triangle and Wilsons Central Terminal.

  • vanessa says:

    I need a a diagram showing where to put the leads  where can i find a picture?

  • Mike says:

    I sincerely appreciate all of the knowldege I've been able to gleen from your website. So that I might further develop my knowledge of interpreting 12 leads, is there a single-book resource you might recommend – something I can have as a "Universal Reference" for those hard to discern 12-leads?
    Thanks a million~~

  • James Pace says:

    Thank You Tom for your incredible lecture at the EMS Expo in New Orleans this past Thursday. I was in the front row with about 5 other co-workers some of who have 15+ years as ALS providers in EMS. I can honestly say that this was, hands down, the best/most concise 12-Lead lesson I have ever been exposed to. And this feeling was shared by all of my co-workers as we walked away from your lecture. Keep up the good work you all do in demystifying this topic and helping to change the way we look at this vital tool in our everyday assessments. J. Pace NREMT-P 

  • Shayna Orsen says:

    I learn something new from ya'll everyday! I'm a huge fan, and when I have questions you're my first resource for answers. Thanks so much for all you do! ~ Shayna Orsen NREMT-P

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EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

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Great case but it stopped short. It should continue. The patient was transferred to an experienced PCI center. Focused medical evaluation was performed in the ED and emergent cardiology consultation was obtained. Although there is not clear ST elevation on the 12 lead the interventional cardiologist knows the data that over 70% of VF cardiac…
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Had a pt today with a rate @ and around 160, it was indeed sinus tachycardia. The tachycardia was secondary to a stimulant which caused over stimulation of sympathetic nervous system ie sympathomimetic O.D. The treatment was fluid and a benzo. Problem solved.
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When looking at how the heart sits in the chest and how things are named remember they were probabily named during autopsys when the cadaver was on its back.
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