Paramedic Ability in Interpreting Electrocardiogram with ST-segment Elevation Myocardial Infarction (STEMI) in Saudi Arabia

Abdullah A Alrumayh; Abdullah M Mubarak; Abdulkarim A Almazrua; Musab Z Alharthi; Deem F Alatef; Turki B Albacker; Fahad M Samarkandy; Yousef M Alsofayan; Muath Alobaida

doi:10.2147/JMDH.S371877

Paramedic Ability in Interpreting Electrocardiogram with ST-segment Elevation Myocardial Infarction (STEMI) in Saudi Arabia

J Multidiscip Healthc. 2022 Aug 4:15:1657-1665. doi: 10.2147/JMDH.S371877. eCollection 2022.

Authors

Abdullah A Alrumayh¹, Abdullah M Mubarak¹, Abdulkarim A Almazrua², Musab Z Alharthi³, Deem F Alatef⁴, Turki B Albacker⁵, Fahad M Samarkandy⁶, Yousef M Alsofayan⁷, Muath Alobaida¹

Affiliations

¹ Department of Basic Sciences, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia.
² Department of Aviation and Marine, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia.
³ Department of Accident and Trauma, Prince Sultan Bin AbdulazizCollege for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia.
⁴ Department of Emergency Medical Services and Disaster Management, King Saud Medical City, Riyadh, Saudi Arabia.
⁵ Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
⁶ Department of Operational Affairs, Saudi Red Crescent Authority, Riyadh, Saudi Arabia.
⁷ Executive Directorate of Medical Affairs, Saudi Red Crescent Authority, Riyadh, Saudi Arabia.

Abstract

Objective: To evaluate paramedic ability in recognizing 12-lead Electrocardiogram (ECG) with ST-segment Elevation myocardial infarction (STEMI) in Saudi Arabia.

Methods: This is a quantitative exploratory cross-sectional study using an electronic survey of paramedics was conducted between June and September 2021. The survey included demographics, educational and clinical experiences, and multiple 12-lead ECG strip questions to assess participants' ability to recognize STEMI. We reported the overall sensitivity, specificity, and correct proportions with 95% Confidence Intervals (CI).

Results: Eighty-four paramedics completed the survey, and 65% of them were between 24 and 29 years old, with a median, of three years of field experience. Overall sensitivity and specificity were 58.39% (95% CI, 50.4% to 66.1%) and 29.01% (95% CI, 25.15% to 33.1%), respectively. In total, 67.1% correctly identified inferior STEMI, whereas only 50% correctly identified lateral STEMI. Both STEMIs were correctly identified by 41%, and the majority misinterpreted STEMI mimics (ECG rhythms with similar ECG morphology to STEMI). The proportion who correctly recognized left bundle branch block was 14.8%, pericarditis was 10.9%, and ventricular pacing was 1.4%. However, almost third of participants correctly identified right bundle branch block (32.9%) and left ventricle hypertrophy (30.7%). Overall, there was no correlation between the correct ECG interpretation of STEMIs and educational and clinical experiences.

Conclusion: Paramedics were able to identify STEMI events in prehospital settings with moderate sensitivity and low specificity with limited ability to differentiate between STEMI and STEMI mimics. Therefore, additional training in ECG interpretation could improve their clinical decision-making, and to ensure that proper care and treatment is provided. Further research on a large, representative sample of paramedics across the country could provide more definitive evidence to establish a greater degree of accuracy in detecting STEMI in prehospital settings.

Keywords: ST segment elevation myocardial infarction; electrocardiogram; emergency medical services; myocardial infarction; paramedic.