Diagnostic Test Performance Characteristics of ST-segment Elevation Myocardial Infarction by Level 1 Emergency Medical Technicians Before vs After an Electrocardiogram Education Program

ABSTRACT

PURPOSE: Pre-hospital diagnosis and activation of a treatment protocol for ST-segment elevation myocardial infarction (STEMI) is the standard of care in developed countries. But the ability of Korean emergency medical technicians (EMTs) to interpret the 12-lead electrocardiogram (ECG) has not been established. The aim of this study was to compare the diagnostic performance of STEMI done by EMTs before and after an ECG education program. METHODS: Seventy three Level-1 EMTs were enrolled from 2006 to 2008 in an eight-week clinical training program. Daily case discussion sessions for interpretation of interpretation of STEMI and acute myocardial infarction, respectively, were followed. before and after the training. EMTs were tested on whether ST elevation was present on the ECG. Correct answer rates of EMTs before and after the education session were compared. We calculated sensitivity, specificity, and accuracy of diagnosis for STEMI. The paired t test was used for statistical analysis. RESULTS: The correct answer rate for all ECG s was 26.8+/-19.3% before education and 45.3+/-26.2% after education. For STEMI ECGs, it was 23.3+/-28.7% before education and 49.7+/-36.2% after education (p<0.001). The performance of EMTs in identifying STEMI on the ECG had a sensitivity of 24.0%, a specificity of 28.9%, and an accuracy of 27.6% before education. After education, these scores were improved to 48.6%, 44.3%, and 45.5% respectively. CONCLUSION: There is significant improvement in ECG interpretation for STEMI through an ECG education program, but accuracy for diagnosis of STEMI by Korean emergency medical technicians was low.