Ability of First-Year Paramedic Students to Identify ST-Segment Elevation Myocardial Injury on 12-Lead Electrocardiogram: A Pilot Study

Abstract

AbstractIntroduction:The purpose of this study was to evaluate the ability of first-year paramedic students to identify ST-segment elevation myocardial injury (STEMI) on 12-lead electrocardiograms (ECGs) following a three-hour presentation by a board-certified emergency medicine physician experienced in ECG interpretation.Methods:Thirty-three first-year paramedic students with minimal to no experience in evaluating 12-lead ECGs were administered a pretest with 20 12-lead ECGs and were asked to evaluate each for: (1) presence of STEMI (STEMI identification); (2) if STEMI presents, ECG leads demonstrating ST-elevation (LEAD identification); and (3) if STEMI present, the anatomic distribution of the STEMI (ANATOMY identification). The students were randomized into two groups. Group 1 (16 students; control group) received a handout describing the evaluation of ECGs for STEMI, while Group 2 (17 students; experimental group) received the handout plus a threehour presentation on the evaluation of ECGs for STEMI. Following randomization, distribution of the STEMI handout and ECG STEMI presentation, a posttest with 20 new ECGs was administered to all participants. The pretest and posttest mean scores were compared between the two groups to determine if attendance at the presentation improved the paramedic students' abilities to evaluate and identify STEMI ECGs. Following the STEMI posttest, students in Group 1 were provided with the STEMI lecture. Students were retested with 20 new ECGs five months following the initial study to examine retention of the information taught.Results:The mean pre-test scores for the two groups (Group 1 vs Group 2, respectively) in STEMI identification (74.4 vs 75.6%; p = 0.79), lead identification (50.0 vs. 51.2%; p = 0.8) and anatomy identification (49.4 vs 51.8%; p = 0.60) were similar in all three categories. Post-test scores between Group 1 and Group 2 demonstrated statistically significant differences in STEMI identification (85.6 vs 92.4%; p <0.02), lead identification (73.4 vs 85.2%; p <0.02), and anatomy identification (65.9 vs 87.1%; p <0.01), with Group 2 demonstrating higher mean scores relative to Group 1 in all three categories. Comparison of mean initial pre-test and five-month retest scores for all students demonstrated statistically significant differences in STEMI identification (75.0 vs 87.4%; p <0.0001), lead identification (50.6 vs 82.2%; p <0.0001), and anatomy identification (50.6 vs 76.6%; p <0.0001).Conclusions:The ability of first-year paramedic students to accurately detect STEMI on prehospital 12-lead ECGs is enhanced by a structured ECG STEMI presentation provided by an emergency medicine physician, and these students maintained excellent retention of STEMI ECG skills over a five-month period.