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Training Day: Mastering the 12-lead

Tips for training EMS providers on interpreting a 12-lead, from studying EKG renderings and understanding their clinical significance


Even at the BLS/EMT level, acquiring a 12-lead ECG is becoming a common skill in many states. So, how can we master this valuable, care-directing and diagnostic-quality skill? Practice, test and reference often.

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Acquiring and interpreting a 12-lead ECG – from the standpoint of a paramedic – is certainly a high-frequency, and even the occasional high-acuity, event.

Even at the BLS/EMT level, acquiring a 12-lead ECG is becoming a common skill in many states.

So, how can we master this valuable, care-directing and diagnostic-quality skill? Practice, test and reference often.

Name that ECG rhythm

Practice doesn’t always equate to perfection, but it does equate to quantity.

Any initial paramedic program should have a built-in, extensive, elaborate and comprehensive ECG rhythm and 12-lead (and even 15- and 18-lead) interpretation component throughout its course.

New paramedic students should get their eyes on, and interpret, hundreds of ECGs – and I mean hundreds!

It’s all about exposure and building a “pattern” to how you interpret your ECG. Creating a step-by-step process to how you tackle this data is imperative at an early stage in the game (and under the controlled environment of a classroom, too!).

Validate your strengths, identify your weaknesses

Testing doesn’t always need to have the punitive component that we associate with it; it can be a valuable evaluation or assessment tool. It can provide validation and help identify areas for improvement.

After learning a new fact, skill, procedure, protocol or calculation, the only way that we can validate that the student has actually retained the information is to test them. This may occur through formal evaluation or informal observation but, in any event, testing is a necessary component of learning.

Paper still has its place in the testing world (or “evaluation world” – if you prefer). New to the market, however, are great electronic options that can be utilized via phone apps, online learning management systems and even via internal agency programs.

The end result of any learning process is to strive toward mastery. ECG acquisition and interpretation shouldn’t be a novice-level skill for paramedic providers – we need to become masters at it! The only way that we can validate this is through testing.

Use a 12-lead reference

Amongst the many (or few) calls that you respond to each year are respiratory complaints, traumatic injuries, coughs and colds, strokes, lift assists and the occasional cardiac event. Having said that, paramedics aren’t cardiologists, but that doesn’t mean we shouldn’t be able to speak their language!

For the complex cases, the atypical presentations and the funky-looking rhythms that you come across, having access to some form of reference can be a very valuable tool.

Interpretation apps can help to pinpoint the nuances of Sgarbossa’s criteria. A reference card can help to identify Takotsubo cardiomyopathy. A chart can help break down the differences between ventricular tachycardia and SVT with aberrancy.

If you don’t commit this information into memory (and no one necessarily says that you should), then invest in a reference guide that can help you recall it in the middle of the night. We use references with pediatric medication doses, why not use them with complex ECG interpretation?

Tim is the founder and CEO of Emergency Medical Solutions, LLC, an EMS training and consulting company that he developed in 2010. He has nearly two decades of experience in the emergency services industry, having worked as a career firefighter, paramedic and critical care paramedic in a variety of urban, suburban, rural and in-hospital environments. His background includes nearly a decade of company officer and chief officer level experience, in addition to training content delivery and program development spanning his entire career. He is experienced in EMS operations, community paramedicine, quality assurance, data management, training, special operations and administration disciplines, and holds credentials as both a supervising and managing paramedic officer.

Tim also has active experience as a columnist and content developer with over 200 published works and over 100 hours of education content available online, and is a social media influencer on LinkedIn within the EMS industry. Connect with him on LinkedIn or at