Abstract

Introduction: The interpretation of electrocardiograms (ECGs) is an essential competency in modern paramedicine. Although educational guidelines for paramedic ECG interpretation exist, they are broad, not evidence-based, and lack prioritization in a prehospital clinical context. We conducted this study to gain consensus among stakeholders (EMS physicians, paramedic educators, and paramedic clinicians) regarding which ECG diagnoses or findings are most important for a practising advanced care paramedic to know. Methods: This study was an internet-based Delphi survey. We purposefully sampled participants in pairs (physician/paramedic) from all 10 Canadian provinces. Individuals rated a previously developed comprehensive list of emergency ECG diagnoses or findings on the importance of paramedic recognition and impact on prehospital care using a 4-point Likert scale. The consensus was achieved with a minimum of 75% agreement on Likert rating for a single diagnosis or finding during survey rounds one to three. When consensus was not reached, stability was defined as a shift of individual ratings between rounds of 20% or less.Results: All 20 participants completed the first and second rounds of the survey, and 17 (85%) completed three rounds. Overall, 32 (26.4%) of 121 potentially important ECG diagnoses or findings reached consensus, 2 (1.7%) reached stability and 87 (71.9%) reached neither consensus nor stability. Twenty-one (17.4%) diagnoses or findings were considered “Very Important”, six (4.9%) “Important”, and five (4.1%) “Minimally Important”. In the first round of the survey, the mean rating of the importance of a paramedic knowing a specific ECG diagnosis or finding was lower in the physician group than the paramedic group on 85 (72%) of 118 initial diagnoses or findings.Conclusion: We have created a list of ECG diagnoses or findings prioritized for the prehospital context that may assist paramedic educators in focusing on educational interventions. Many ECG diagnoses or findings failed to reach consensus or stability, demonstrating potential disagreement regarding clinical expectations for ECG knowledge among paramedics or physicians.

Highlights

  • The interpretation of electrocardiograms (ECGs) is an essential competency in modern paramedicine

  • We have created a list of ECG diagnoses or findings prioritized for the prehospital context that may assist paramedic educators in focusing on educational interventions

  • In round one of the surveys, we provided the participants with a previously developed, comprehensive list of 118 individual emergency ECG diagnoses or findings grouped into six categories: Pacemaker, Ischemia/STsegment changes, Dysrhythmia/blocks, Genetic, Miscellaneous/ECG findings, Electrolyte/Toxicological [6]

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Summary

Introduction

The interpretation of electrocardiograms (ECGs) is an essential competency in modern paramedicine. Educational guidelines for paramedic ECG interpretation exist, they are broad, not evidence-based, and lack prioritization in a prehospital clinical context. The interpretation of electrocardiograms (ECGs) is an essential skill in modern paramedicine. Educational guidelines for paramedic ECG interpretation exist [1,2], they are broad, not evidence-based, and lack prioritization in a prehospital clinical context. In Canada, the National Occupational Competency Profile (NOCP) largely dictates the scope and practice of paramedics [1]. This document, produced by the Paramedic Association of Canada, helps to define the profession and promote consistency in paramedicine training and practice at a national level. The document does not provide specific direction on what ECGs an advanced paramedic must be able to recognize

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