ECG interpretation in rescue and emergency medical services in Germany: results of a cross-sectional study

Background: The recording of an electrocardiogram (ECG) is an essential part of basic diagnostics in the emergency medical services (EMS). To provide initial care and make a preliminary diagnosis, paramedics and emergency physicians (EP) need knowledge about the ECG interpretation. Nevertheless, a few studies show that knowledge of ECG interpretation of paramedics and emergency physicians must improve. Objectives: The aim of this study was to analyze the ECG interpretation skills among EMS staff and EP in Germany. Materials and methods: An online survey was conducted to assess these skills from 22 February to 22 March 2023. The survey collected details about gender, age, professional training, years of professional experience, time since the last ECG training, and self-rated ECG interpretation ability. Subsequently, 9 different ECG had to be interpreted in the form of single-choice questions. Results: In all, 908 participants (EMS: 803; EP: 105) were evaluated. The survey identified a knowledge deficit in the interpretation of ECG. On average, 63.3% (EMS: 61.4%; EP: 76.5%) of the ECG were interpreted correctly. The ECG with ST-elevation myocardial infarction (STEMI) of the posterior wall was identified correctly by 79.1% (EMS: 78.1%; EP: 86.7%) of the participants. Specific weak points in interpreting ECG were AV-blocks, tachycardias, atrial fibrillation, bundle branch blocks, pacemaker ECG and determining the ventricular axis. The participants' self-assessment of their ECG skills correlated significantly with the results actually achieved (p <= 0.001; p(bonf )= 0.016; rho = 0.378). Conclusion: Based on the lack of diagnostic skills in the interpretation of a 12 lead ECG, continuous education programs should be revised to improve the quality of patient care in prehospital emergency medicine.