Paramedics who identified STEMI at any time bypassed participating local EDs, taking patients directly to the percutaneous coronary intervention (PCI) center. If the first ECG did not identify STEMI, protocol required a second ECG just before transport and, if necessary, a third ECG before entering the receiving ED. We retrospectively analyzed 325 consecutive prehospital STEMIs identified between June 2008 and May 2009 in a large third-service emergency medical services (EMS) system. To determine how often the first and, if necessary, second or third prehospital ECGs identified STEMI, and the time intervals associated with acquiring these ECGs and arrival at the emergency department (ED). However, it is known that ECG evidence of STEMI can evolve over time. Many prehospital protocols require acquisition of a single 12-lead electrocardiogram (ECG) when assessing a patient for ST-segment elevation myocardial infarction (STEMI).
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