Out-of-Hospital 12-Lead ECG

Reaffirmed by the ACEP Board of Directors October 2006
Originally approved by the ACEP Board of Directors June 1999 

The American College of Emergency Physicians (ACEP) believes that the
out-of-hospital 12-lead ECG may facilitate early identification of patients with acute coronary syndromes.

• Considerations for implementation of out-of-hospital 12-lead ECG programs should include local factors, such as EMS vehicle staffing, response and transport times, and the capabilities and resources of local emergency departments.
  
   
• The 12-lead ECG in the out-of-hospital setting should only be obtained in patients presenting with symptoms typical of an acute coronary syndrome. Utilization and transmission of this ECG should be defined by local protocol under appropriate physician medical direction.
  
   
• Use of the 12-lead ECG in the out-of-hospital setting should not unduly prolong field times or delay implementation of already existing chest pain protocols.
  
   
• The out-of-hospital 12-lead ECG, if normal, does not exclude the possibility of ischemic cardiac disease and must not be used to screen patients.
  
   
• EMS systems should continuously monitor the medical impact of
  out-of-hospital 12-lead ECG programs.

The out-of-hospital 12-lead ECG should be viewed as part of a continuum of patient care, including treatment that may produce resolution of ischemic changes. It should not replace timely emergency department evaluation and treatment.