SKILLS: 12-LEAD EKG – BIENNIAL COMPETENCY

(NOT IN EMT- II SCOPE OF PRACTICE)

Name:________________________________ Cert #:________________
PURPOSE: To better assess acute coronary syndrome (ACS) patients.

DEFINITION: Performance of 12-Lead EKGs is an optional assessment procedure in California and Nor-
Cal EMS scopes of practice.

POLICY:
1. This procedure is indicated in Acute Coronary Syndrome (ACS) patients to:
a. Provide a baseline study for later comparison.
b. To help determine the presence of electrocardiographic evidence of myocardial infarct or
ischemia.
c. Assess the presence and/or degree of ST elevation.
2. If the 12-Lead EKG is positive for ST elevation, immediately transmit to the receiving hospital without
delaying assessment and treatment of the patient.
3. Indications: Medical history and/or presenting complaints consistent with acute coronary syndrome
(ACS). Patients will have one or more of the following signs/symptoms:
a. Chest or upper abdominal discomfort suggestive of acute coronary syndrome.
b. Discomfort or tightness with radiation to jaw, neck, left shoulder, back, or left arm, and may have
one of the following:
Ø Nausea
Ø Diaphoresis
Ø Dyspnea
Ø Unexplained syncope or near syncope (elderly).
c. New onset cardiac dysrhythmia.
d. Onset of dyspnea suggestive of congestive heart failure.
e. Other Signs or SXs suggestive of acute coronary syndrome.
4. Contraindications: Do NOT perform ECG on these pts.:
a. Trauma. There must be no delay in transport.
b. Cardiac Arrest.
c. Respiratory Arrest.

5. Base Hospital Communication: Paramedics and MICNs may attempt base hospital contact after
this procedure is performed.
6. Documentation: Documentation will be completed per the Documentation, Reporting, and
Retention policy located in the Miscellaneous Policies Module. A copy of the 12-Lead EKG and
PCR shall be turned into the RF and BH, along with a Skills/Medication Usage Form located in the
Provider Agreements Module.
Met Not Met
Performance Criteria Initials Initials
Comments

1. Do not delay assessment and treatment. Follow appropriate

policies regarding the patient’s clinical assessment, i.e, Chest
Pain protocol.
2. Explain to the patient the procedure and the importance of
obtaining an EKG.
3. Expose the chest and prepare the patient’s skin for electrode
placement. Dry the skin if it is excessively moist. If there is
significant chest hair, use a razor to shave areas where leads
will be placed.

Policy & Procedure Manual - ALS Protocols Module

Originated: January 1, 2006
Last Revision: January 1, 2006

Skills: 12-Lead EKG, Biennial Competency - #913

 SKILLS: 12-LEAD EKG – BIENNIAL COMPETENCY
(NOT IN EMT- II SCOPE OF PRACTICE)
Met Not Met
Performance Criteria Initials Initials
Comments

4. EKGs on female patients:

a. Be sensitive when exposing or touching the breast.
a. If possible, the bra should be left on.
b. The supine position is preferred to assist in
displacement of the breast.
c. Always place the V3-V6 leads under the breast, rather
than on the breast.
d. Always use the back of your hand and never the palm
when displacing the breast.
5. Attach EKG leads to the patient:
a. Place the electrodes on the limbs. The limb leads can
be placed anywhere from the shoulders to the wrist
and the thighs to the ankles – NOT the torso.
b. Place the electrodes on the chest. The six precordial
(chest) lead electrodes:
th
Ø V1: right 4 intercostal space, just to the right of
the sternum.
th
Ø V2: left 4 intercostal space, to the left of the
sternum.
Ø V3: Halfway between V2 and V4
th
Ø V4: Left 5 intercostals space, midclavicular line
Ø V5: Horizontal to V4, anterior axillary line
Ø V6: Horizontal to V5, mid-axillary line
6. Encourage the patient to remain as still as possible and not to
talk.
7. Run the 12-Lead EKG.
8. The 12-Lead/Age menu will appear. Select the patient’s age.
9. If the monitor detects noise (such as patient motion or a
disconnected electrode), the 12-Lead is interrupted. Take
appropriate action and run the 12-Lead again.
10. If the 12-Lead EKG shows ST elevation in 2 or more
contiguous leads, and the patient has experience or is
experiencing chest pain, or at the discretion of the paramedic,
immediately transmit the 12-lead EKG to the RF.
Transmit from a landline, if possible
Make no more that two attempts to transmit from a landline
Continue attempts to transmit while enroute if possible.
11. Notify the RF with a verbal report; include interpretation of ST
elevation including involved leads and millimeters of elevation.
12. Documentation: Attach a copy of the 12-lead EKG to the PCR.
VALIDATOR’S SIGNATURE ALS PROVIDER’S SIGNATURE DATE

Policy & Procedure Manual - ALS Protocols Module

Originated: January 1, 2006
Last Revision: January 1, 2006

Skills: 12-Lead EKG, Biennial Competency - #913