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Background: Prehospital 12‑lead electrocardiogram (ECG) is the most widely used screening tool for recognition of ST-segment elevation myocardial infarction (STEMI). However, prehospital diagnosis of STEMI based solely on ECGs can be challenging., Objectives: To evaluate the ability of emergency department (ED) physicians to accurately interpret prehospital 12‑lead ECGs from a remote location., Methods: All suspected prehospital STEMI patients who were transported by EMS and underwent angiography between 2006 and 2014 were included. We reviewed prehospital ECGs and grouped them based on: 1) presence or absence of a culprit artery lesion following angiography; and 2) whether they met the 3rd Universal Definition of Myocardial Infarction. We also described characteristics of ECGs that were misinterpreted by ED physicians., Results: A total of 625 suspected STEMI cases were reviewed. Following angiography, 94% (590/625) of patients were found having a culprit artery lesion, while 6% (35/625) did not. Among these 35 patients, 24 had ECGs that mimicked STEMI criteria and 9 had non-ischemic signs. Upon ECG reinterpretation, 92% (577/625) had standard STEMI criteria while 8% (48/625) did not. Among these 48 patients, 35 had ischemic signs ECGs and 13 did not. Characteristics of misinterpreted ECGs included pericarditis, early repolarization, STE > 1 mm (1‑lead only), and negative T-wave., Conclusions: Remote interpretation of prehospital 12‑lead ECGs by ED physicians was a useful diagnostic tool in this EMS system. Even if the rate of ECG misinterpretation is low, there is still room for ED physicians operating from a remote location to improve their ability to accurately diagnose STEMI patients., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: Repeated or serial 12-lead electrocardiograms (ECGs) in the prehospital setting may improve management of patients with subtle ST-segment elevation (STE) or with a ST-segment elevation myocardial infarction (STEMI) that evolves over time. However, there is a minimal amount of scientific evidence available to support the clinical utility of this method. Our objective was to evaluate the use of serial 12-lead ECGs to detect STEMI in patients during transport in a Canadian emergency medical services (EMS) jurisdiction., Methods: We performed a retrospective study of suspected STEMI patients transported by EMS in the Chaudière-Appalaches region (Québec, Canada) between August 2006 and December 2013. Patients were monitored by a serial 12-lead ECG system where an averaged ECG was transmitted every 2 minutes. Following review by an emergency physician, ECGs were grouped as having either a persistent STE or a dynamic STE that evolved over time., Results: A total of 754 suspected STEMI patients were transported by EMS during the study period. Of these, 728 patients met eligibility criteria and were included in the analysis. A persistent STE was observed in 84.3% (614/728) of patients, while the remaining 15.7% (114/728) had a dynamic STE. Among those with dynamic STE, 11.1% (81/728) had 1 ST-segment change (41 no-STEMI to STEMI; 40 STEMI to no-STEMI) and 4.5% (33/728) had ≥ 2 ST-segment changes (17 no-STEMI to STEMI; 16 STEMI to no-STEMI). Overall, in 8.0% (58/728) of the cohort, STEMI was identified on a subsequent ECG following an initial no-STEMI ECG., Conclusions: Through recognition of transient ST-segment changes during transport via the prehospital serial 12-lead ECG system, STEMI was identified in 8% of suspected STEMI patients who had an initial no-STEMI ECG. Key words: electrocardiography; emergency medical services; ST-elevation myocardial infarction; prehospital dynamic ECG.

Access to health care in Canada's rural areas is a challenge. The Unité de Coordination Clinique des Services Préhospitaliers d'Urgence (UCCSPU) is a telemedicine program designed to improve health care in the Chaudiere-Appalaches and Quebec City regions of Canada. Remote medical services are provided by nurses and by an emergency physician based in a clinical unit at the Alphonse-Desjardins Community Health and Social Services Center. The interventions were developed to meet two objectives. The first is to enhance access to quality health care. To this end, Basic Life Support paramedics and nurses were taught interventions outside of their field of expertise. Prehospital electrocardiograms were used to remotely diagnose ST segment elevation myocardial infarction and to monitor patients who were en route by ambulance to the nearest catheterization facility or emergency department. Basic Life Support paramedics received extended medical authorization that allowed them to provide opioid analgesia via telemedicine physician orders. Nurses from community health centres without physician coverage were able to request medical assistance via a video telemedicine system. The second objective is to optimize medical resources. To this end, remote death certifications were implemented to avoid unnecessary transport of deceased persons to hospitals. This paper presents the telemedicine program and some results. [ABSTRACT FROM AUTHOR]

Background: As per American Heart Association/American College of Cardiology guidelines, the delay between first medical contact and balloon inflation should not exceed 90 min for primary percutaneous coronary intervention (PCI). In North America, few prehospital systems have been developed to grant rural populations timely access to PCI.Objectives: The objective of the present study was to evaluate the ability of an ST-segment elevation myocardial infarction (STEMI) system serving suburban and rural populations to achieve the recommended 90-min interval benchmark for PCI.Methods: A prehospital telemedicine program was implemented in a rural and suburban region of the Quebec province. Three patient groups with STEMI were created according to trajectory: 1) patients already en route to a PCI center, 2) patients initially directed to the nearest hospital who were subsequently diverted to a PCI center during transport, and 3) patients directed to the nearest hospital without transfer for PCI. Time intervals were compared across groups.Results: Of the 208 patients diagnosed with STEMI, 14.9% were already on their way to a hospital with PCI capabilities, 75.0% were rerouted to a PCI center, and 10.1% were directed to the nearest local hospital. All patients but one arrived at the PCI center within the 60-min prehospital care interval, considering an additional 30 min for balloon inflation at the PCI center.Conclusion: This study demonstrated that a regionalized prehospital system for STEMI patients could achieve the recommended 90-min interval benchmark for PCI, while giving timely access to PCI to rural populations that would not otherwise have access to this treatment. [ABSTRACT FROM AUTHOR]