{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T08:06:03Z","timestamp":1783065963440,"version":"3.54.6"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2013,8,22]]},"abstract":"\n Background<\/jats:title>\n \n Prehospital 12\u2010lead electrocardiography (\n ECG<\/jats:styled-content>\n ) is critical to timely\n STEMI<\/jats:styled-content>\n care although its use remains inconsistent. Previous studies to identify reasons for failure to obtain a prehospital\n ECG<\/jats:styled-content>\n have generally only focused on individual emergency medical service\n (EMS)<\/jats:styled-content>\n systems in urban areas. Our study objective was to identify patient, geographic, and\n EMS<\/jats:styled-content>\n agency\u2010related factors associated with failure to perform a prehospital\n ECG<\/jats:styled-content>\n across a statewide geography.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n We analyzed data from the Prehospital Medical Information System (Pre\n MIS<\/jats:styled-content>\n ) in\n N<\/jats:styled-content>\n orth\n C<\/jats:styled-content>\n arolina from January 2008 to November 2010 for patients >30\u00a0years of age who used\n EMS<\/jats:styled-content>\n and had a prehospital chief complaint of chest pain. Among 3.1 million\n EMS<\/jats:styled-content>\n encounters, 134\u00a0350 patients met study criteria. From 2008\u20132010, 82\u00a0311 (61%) persons with chest pain received a prehospital\n ECG<\/jats:styled-content>\n ; utilization increased from 55% in 2008 to 65% in 2010 (trend\n P<\/jats:italic>\n <0.001). Utilization by health referral region ranged from 22.9% to 74.2% and was lowest in rural areas. Men were more likely than women to have an\n ECG<\/jats:styled-content>\n performed (63.0% vs 61.3%, adjusted\n RR<\/jats:styled-content>\n 1.02, 95%\n CI<\/jats:styled-content>\n 1.01 to 1.04). The certification\u2010level of the\n EMS<\/jats:styled-content>\n provider (paramedic vsbasic\/intermediate) and system\u2010level\n ECG<\/jats:styled-content>\n equipment availability were the strongest predictors of\n ECG<\/jats:styled-content>\n utilization. Persons in an ambulance with a certified paramedic were significantly more likely to receive a prehospital\n ECG<\/jats:styled-content>\n than nonparamedics (\n RR<\/jats:styled-content>\n 2.15, 95%\n CI<\/jats:styled-content>\n 1.55, 2.99).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Across a large geographic area prehospital\n ECG<\/jats:styled-content>\n use increased significantly, although important quality improvement opportunities remain. Increasing\n ECG<\/jats:styled-content>\n availability and improving\n EMS<\/jats:styled-content>\n certification and training levels are needed to improve overall care and reduce rural\u2010urban treatment differences.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.113.000289","type":"journal-article","created":{"date-parts":[[2013,8,7]],"date-time":"2013-08-07T00:17:19Z","timestamp":1375834639000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Variation in the Use of 12\u2010Lead Electrocardiography for Patients With Chest Pain by Emergency Medical Services in North Carolina"],"prefix":"10.1161","volume":"2","author":[{"given":"Montika","family":"Bush","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, University of North Carolina (UNC) School of Medicine, Chapel Hill, NC"},{"name":"UNC Gillings School of Global Public Health, Chapel Hill, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence T.","family":"Glickman","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of North Carolina (UNC) School of Medicine, Chapel Hill, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio R.","family":"Fernandez","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of North Carolina (UNC) School of Medicine, Chapel Hill, NC"},{"name":"EMS Performance Improvement Center, Chapel Hill, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. L.","family":"Garvey","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seth W.","family":"Glickman","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of North Carolina (UNC) School of Medicine, Chapel Hill, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.09.030"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2006.08.009"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2008.11.013"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.118463"},{"key":"e_1_3_3_6_2","first-page":"I172","article-title":"The American Heart Association in collaboration with the International Liaison Committee on Science Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care. An international consensus on science. Part 7: the era of reperfusion: section 1: acute coronary syndromes (acute myocardial infarction)","volume":"102","year":"2000","unstructured":"The American Heart Association in collaboration with the International Liaison Committee on Science Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care. An international consensus on science. Part 7: the era of reperfusion: section 1: acute coronary syndromes (acute myocardial infarction). Circulation. 2000;102:I172\u2013I203.","journal-title":"Circulation"},{"key":"e_1_3_3_7_2","first-page":"846","article-title":"31st Bethesda conference. Emergency cardiac care. Task force 2: acute coronary syndromes: section 2A\u2014prehospital issues","volume":"35","author":"Hutter AM","year":"2000","unstructured":"Hutter AM, Weaver WED. 31st Bethesda conference. Emergency cardiac care. Task force 2: acute coronary syndromes: section 2A\u2014prehospital issues. J Am Coll Cardiol. 2000;35:846\u2013853.","journal-title":"J Am Coll Cardiol"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1080\/10903120290938599"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2004.07.014"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2005.08.072"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.068049"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.3109\/10903120903349846"},{"key":"e_1_3_3_13_2","first-page":"11","volume-title":"The Dartmouth Atlas of Health Care","author":"Cooper MM","year":"1996","unstructured":"Part one: the geography of health care in the United States. In Cooper MM, ed. The Dartmouth Atlas of Health Care. Chicago, Illinois: American Hospital Publishing, Inc; 1996:11\u201336."},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/hs1001.096047"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.3109\/10903127.2011.615008"},{"key":"e_1_3_3_16_2","unstructured":"Paramedic national standard curriculum. Available at http:\/\/www.ems.gov\/EducationStandards.htm. Accessed April 24 2013."}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.113.000289","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T10:44:12Z","timestamp":1715597052000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.113.000289"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,8,22]]},"references-count":15,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2013,8,22]]}},"alternative-id":["10.1161\/JAHA.113.000289"],"URL":"https:\/\/doi.org\/10.1161\/jaha.113.000289","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,8,22]]},"assertion":[{"value":"2013-05-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2013-07-16","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2013-08-06","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e000289"}}