Indian and United States paramedic students: comparison of examination performance for the American Heart Association Advanced Cardiovascular Life Support (ACLS) training.

BACKGROUND: The American Heart Association (AHA) Advanced Cardiovascular Life Support (ACLS) course is taught worldwide. The ACLS course is designed for consistency, regardless of location; to our knowledge, no previous study has compared the cognitive performance of international ACLS students to those in the United States (US). STUDY OBJECTIVES: As international health educational initiatives continue to expand, an assessment of their efficacy is essential. This study assesses the AHA ACLS curriculum in an international setting by comparing performance of a cohort of US and Indian paramedic students. METHODS: First-year paramedic students at the Emergency Management and Research Institute, Hyderabad, India, and a cohort of first-year paramedic students from the United States comprised the study population. All study participants had successfully completed the standard 2-day ACLS course, taught in English. Each student was given a 40-question standardized AHA multiple-choice examination. Examination performance was calculated and compared for statistical significance. RESULTS: There were 117 Indian paramedic students and 43 US paramedic students enrolled in the study. The average score was 86% (± 11%) for the Indian students and 87% (± 6%) for the US students. The difference between the average examination scores was not statistically significant in an independent means t-test (p=0.508) and a Wilcoxon test (p=0.242). CONCLUSION: Indian paramedic students demonstrated excellent ACLS cognitive comprehension and performed at a level equivalent to their US counterparts on an AHA ACLS written examination. Based on the study results, the AHA ACLS course proved effective in an international setting despite being taught in a non-native language.

Ability of First-Year Paramedic Students to Identify ST-Segment Elevation Myocardial Injury on 12-Lead Electrocardiogram: A Pilot Study.

INTRODUCTION: The purpose of this study was to evaluate the ability of firstyear paramedic students to identify ST-segment elevation myocardial injury (STEMI) on 12-lead electrocardiograms (ECGs) following a three-hour presentation by a board-certified emergency medicine physician experienced in ECG interpretation. METHODS: Thirty-three first-year paramedic students with minimal to no experience in evaluating 12-lead ECGs were administered a pre-test with 20 12-lead ECGs and were asked to evaluate each for: (1) presence of STEMI (STEMI identification); (2) if STEMI presents, ECG leads demonstrating ST-elevation (LEAD identification); and (3) if STEMI present, the anatomic distribution of the STEMI (ANATOMY identification). The students were randomized into two groups. Group 1 (16 students; control group) received a handout describing the evaluation of ECGs for STEMI, while Group 2 (17 students; experimental group) received the handout plus a three hour presentation on the evaluation of ECGs for STEMI. Following randomization, distribution of the STEMI handout and ECG STEMI presentation, a post-test with 20 new ECGs was administered to all participants. The pretest and post-test mean scores were compared between the two groups to determine if attendance at the presentation improved the paramedic students' abilities to evaluate and identify STEMI ECGs. Following the STEMI posttest, students in Group 1 were provided with the STEMI lecture. Students were retested with 20 new ECGs five months following the initial study to examine retention of the information taught. RESULTS: The mean pre-test scores for the two groups (Group 1 vs Group 2, respectively) in STEMI identification (74.4 vs 75.6%; p=0.79), lead identification (50.0 vs. 51.2%; p=0.8) and anatomy identification (49.4 vs 51.8%; p=0.60) were similar in all three categories. Post-test scores between Group 1 and Group 2 demonstrated statistically significant differences in STEMI identification (85.6 vs 92.4%; p<0.02), lead identification (73.4 vs 85.2%; p<0.02), and anatomy identification (65.9 vs 87.1%; p<0.01), with Group 2 demonstrating higher mean scores relative to Group 1 in all three categories. Comparison of mean initial pre-test and five-month retest scores for all students demonstrated statistically significant differences in STEMI identification (75.0 vs 87.4%; p<0.0001), lead identification (50.6 vs 82.2%; p<0.0001), and anatomy identification (50.6 vs 76.6%; p<0.0001). CONCLUSIONS: The ability of first-year paramedic students to accurately detect STEMI on prehospital 12-lead ECGs is enhanced by a structured ECG STEMI presentation provided by an emergency medicine physician, and these students maintained excellent retention of STEMI ECG skills over a five-month period.