Acquiring and Transmitting a BLS 12-LEAD when Suspecting STEMI

This is a jurisdictional optional protocol that has been adopted by MIEMSS Region I. Per protocol, those persons who have been an EMT for at least one year, with permission and training of their department officer can acquire a 12-LEAD EKG on a patient who is SUSPECTED of having a STEMI (S T Elevation with Myocardial Infarction) for the purpose of transmitting to WMHS to activate the STEMI Team prior to your arrival. Additionally, a ALS provider may request you assist them with this skill.

First some important background information to know:

12-Lead Explained

One of the most common questions regarding a 12-lead ECG is why there are only 10 electrodes. It’s important to fully understand what the term “lead” actually means. A lead is a view of the electrical activity of the heart from a particular angle across the body. Think of a lead as a picture of the heart and the 10 electrodes give you 12 pictures. In other words, a lead is a picture that is captured by a group of electrodes.

Reducing Artifact

The heart’s electrical signal is very small and unfortunately this can be combined with other signals of similar frequency to create artifact. It’s not uncommon for 12-lead ECG’s to have some form of artifact; however, it’s important to try to reduce any interference to ensure an accurate ECG. Below is a list of guidelines that will help reduce artifact when performing ECG’s.

Patient Positioning

Place the patient in a supine or semi-Fowler’s position. If the patient cannot tolerate being flat, you can do the ECG in a more upright position.

Instruct the patient to place their arms down by their side and to relax their shoulders. Make sure the patient’s legs are uncrossed. Move any electrical devices, such as cell phones, away from the patient as they may interfere with the machine.

Skin Preparation

Dry the skin if it’s moist or diaphoretic. Shave any hair that interferes with electrode placement. This will ensure a better electrode contact with the skin. Rub an alcohol prep pad or benzoin tincture on the skin to remove any oils and help with electrode adhesion.

Electrode Application

Check the electrodes to make sure the gel is still moist. Do not place the electrodes over bones. Do not place the electrodes over areas where there is a lot of muscle movement.

To acquire a 12-LEAD, follow these steps:First, place the electrodes in their proper place. Proper placement is CRITICAL; as incorrect placement can lead to a false diagnosis. Place as follows:

To acquire and transmit a 12-LEAD to WMHS using the LifePack1. Once your electrodes have been correctly placed, press

the “Options” button on the right side of the LifePack. Then click “Patient”

2. Input the following information that is REQUIRED by the hospital: Last Name of Patient First Name of Patient Age Date of Birth

You will utilize the speed dial to move between options and select.

This information allows the ED staff to look up the patients record prior to your arrival.

3. Press the 12-LEAD button on the left hand side of the LifePack and instruct the patient to remain as still as possible.

4. Once it has been acquired, select the “Transmit” button on the left hand side of the LifePack:

- Site: WMHS- Report: 12-LEAD

Click “Send”

Finally, once you get to the hospital, you are REQUIRED to complete the Pilot Program Report. These are found on green half-sheets of paper in the EMS Room at the ED. You will need your eMEDS number to complete the report. Once it is completed, slip it under Bill Hardy’s office door. He will then send you a letter with your patients outcome.