EMS protocol gaps for defibrillator pad placement in prehospital STEMI care

Abstract

Background: Patients experiencing ST-segment elevation myocardial infarction (STEMI) face a significant risk of sudden cardiac arrest (SCA) in the prehospital setting, often presenting as shockable rhythms. Early defibrillation is critical to survival, and preemptive placement of defibrillator pads may reduce time to shock. However, the extent to which EMS protocols recommend this practice remains unclear. Objective: To assess the prevalence and specificity of guidance on defibrillator pad placement for STEMI patients in U.S. EMS protocols and identify gaps in prehospital care. Methods: We conducted a cross-sectional review of 30 publicly available state-wide EMS protocols or recommendations. We analyzed Protocols for recommendations on defibrillator pad placement during STEMI transport, ECG acquisition timing, and hospital notification. Findings were summarized using descriptive statistics. Results: Only 13% of protocols explicitly advised placing defibrillator pads on STEMI patients during transport, while 17% suggested considering pad placement. The remaining 70% provided no guidance. Few protocols specified ECG acquisition timing goals (33%), though 67% emphasized early STEMI notification to receiving hospital. Conclusions: EMS protocol guidance on defibrillator pad placement for STEMI patients remains limited and variable. Most protocols lack clear recommendations, potentially delaying rapid defibrillation during cardiac arrest. Further research should assess the clinical impact, cost-effectiveness, and implementation barriers of routine preemptive pad placement during STEMI transport.