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A lot of people have asked me about calling STEMI alerts on patients. I know a lot of different departments have different protocols regarding the terminology of this practice such as “STEMI Alert” or “Cardiac Alert” or whatever. The fact remains, that all this talk you hear about “don’t call it unless you know for sure because it costs the hospital a billion dollars to activate the cath lab” is garbage.

Embedded in the paramedic curriculum is, I will admit, more 12 lead education than before the “EMS Agenda for the Future” but nowhere near the level of what ER docs are expecting the bread and butter paramedic to be able to recite. I witnessed a doctor grilling a paramedic at one of my local hospitals because he didn’t know who to recognize Wellen’s on his 12 lead. Although I do understand the importance of this stuff, you can’t fault the paramedic for not initiated the alert or not initiated the alert based on the curriculum they have been taught. Until the EMS community and the national standards embrace the fact that our first responders are the ones who should be 12 lead experts, than paramedics are continuously mis-read the ECG. Do a test! Ask the nearest competent medic if they can recite Sgarbossa and see what happens.

With that being said, JUST CALL IT! Keep the mindset “If it looks like V-Tach, treat it like V-Tach”. At this stage in the game don’t worry about differentiating pericarditis from Anterior Wall MI. Just call it! Always err on the side of patient safety. If you have telemetry…GREAT! Send it! If not use your best judgment. Transport your patient and learn from what you did. After your transport go home and study and read up on pericarditis and learn about the ECG differences. Next time you have that situation you will be more in tune with the call and act more accordingly.

Now I know what some of you are saying..“Well what if it is a hemorrhagic tamponade causing signs of pericarditis and you treated with Aspirin because you didn’t know the difference”. I get it! What I am saying is if you ever have the question “Should I call a STEMI on this patient” roll through your head, just call it. Never go back to your station or post second saying “I should have done something else”. Act in the best interest of your patient and study for the next time. As EMS providers we SHOULD be 12 lead experts but this takes time and practice to the point of nausea. That is the purpose of this site and podcasts. It is to make us all better in what we do.

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