An article in the curent issue of EMS World argues for the acquisition and transmission of prehospital ECGs by BLS crews. No argument there - that is exactly what happens in the ED. A tech acquires the ECG and runs it to me. If your system allows for easy transmission of ECGs, and if paramedics are scarce, this would be a common-sense approach to take.
Unfortunately, an accompanying illustration distracts from the main message.
First, I believe V1 and V2 are located too high on the chest.
These leads should be located in the forth intercostal space (ICS), which in males is often within a fingerbreadth of the horizontal nipple line.
A second apparent error is that V3 is shown slightly medial to V2.
It should properly be placed halfway in between leads V2 and V4.
Why is this important?
Misplacement of ECG leads, and especially V1 and V2, are common. One study compared the accuracy of cardiac techs, compared with nurse, physicians, and even cardiologists. No one, except the techs, came out looking too good.
|The ovals represent the range of misplacement for each lead, broken down by training level. Ref.|
(Interesting aside - placing the leads in a higher ICS is used to assess for an occult Brugada pattern, But this is sort of a specialized technique, and I leave it to the electrophysiologists.)
A recent post from Captain Chair Confessions highlighted the importance of proper lead placement, not only with regard to accuracy, but also in assuring that EMS appears professional and competent. I second that, but I have to acknowledge that many paramedics likely learned the incorrect position from preceptors within the hospital. Heck, in one of the studies mentioned above, the cardiologists were the people least likely to properly position V1 and V2!
So, kudos to David Howerton and the other authors on making a good argument for ECG acquisition as a BLS skill! But strive to demonstrate proper lead placement - it makes a difference