Crews aid ECG study

A study that is looking to see if more heart attacks can be identified and earlier could lead to hundreds of lives being saved across not just the UK, but around the world.

The research being carried out by three ambulance services is being funded by the British Heart Foundation and will try to establish the best way to diagnose people having a heart attack.

In the UK there are nearly 200,000 hospital visits each year due to heart attacks: the equivalent of one every three minutes. In the 1960s more than 7 out of 10 heart attacks in the UK were fatal however, advances in treatment mean that today at least 7 out of 10 people survive.

Now, frontline ambulance crews from West Midlands, South Western and the Welsh Ambulance Services will work with researchers at Kingston University and St George's, University of London, Swansea University and the University of Leeds to identify if there are additional times when ambulance crews should perform an ECG (electrocardiogram) test.

Currently a pre-hospital ECG is performed on patients complaining of acute chest pain. The device measures electrical activity in the heart through a series of wires attached to the patient's chest.

Research Paramedic Josh Miller, said: "Data already shows that in about a third of cases, when a patient is having a heart attack, they haven't had an ECG done by the ambulance crew because the patient didn't show any of the classic signs - chest pain or pain in the arm, neck, and jaw, or feelings of sickness, light-headedness or shortness of breath.

"Earlier studies show that this is more common in older people and particularly women. Because of this, the study will look to see if there are other atypical signs that ambulance staff should be looking out for.

"This is important because if an ECG was done on these patients they would get the specialist treatment they need more quickly, which might result in the crew bypassing the local hospital and going straight to a specialist centre, which means more patients will survive.

"In this study we will be looking back at the medical records where we know the patient had had a heart attack to look at whether an ECG was done by the ambulance crew, and if not, if there is an indication as to why they didn't do one.
"We will also hold focus groups with paramedics to understand better their decision making processes on whether to do an ECG."

As for what the outcome of the study might be, Josh says, there will be no immediate changes for ambulance crews but the study could lead to significant developments worldwide: "We might need to change our advice to ambulance staff as to when they choose to do an ECG so that they do an ECG more often and therefore pick up more heart attacks.

"The second area that might change is around ambulance workforce provision; currently, not all ambulance services in the world have a paramedic on every ambulance, as is the case in the West Midlands. By having a paramedic on board would mean that there is someone who is trained to interpret an ECG which would allow them to identify if there is a heart attack ongoing which would lead to the patient getting taken straight to a specialist centre."

Josh says, when you talk to patients who have had heart attacks, many were absolutely stunned that that is what was happening.

It's not just members of the public who don't recognise they are having a heart attack. Retired GP, Dr Richard Johnson from North Worcestershire didn't realise until he saw the ECG that the ambulance crew carried out on him. He ended up being blue lighted straight to theatre for emergency surgery.

Tom Quinn, Professor of Cardiovascular Nursing who is leading the project, added: "Ambulance staff play a crucial role in early assessment of patients with a suspected heart attack. Previous research has shown that people receiving the test were more likely to survive.

"There could be a variety of reasons why around a third of heart attack patients don't get an ECG from ambulance crews; for example, we know that women and older people are less likely to receive one, perhaps because of cultural issues, not wanting to overplay the seriousness of the situation or because some heart attack patients do not report 'classic chest pain' type symptoms.

"By looking at nationwide data on the treatment of heart attacks and by speaking to ambulance crews working on the frontline we hope to develop a clearer picture of when these ECGs should be used. We can use this knowledge to empower ambulance crews, help them make the most effective decisions and ultimately save more lives."

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