Nationwide Survey of Prehospital 12‑lead Electrocardiogram Recording and Transmission in Japan: Equipment Availability Is No Longer the Major Barrier.

BACKGROUND

Prehospital 12‑lead electrocardiogram (ECG) improves survival in patients with ST-segment elevation myocardial infarction (STEMI). However, the current status of prehospital 12‑lead ECG recording and transmission by emergency medical services (EMS) in Japan has not been investigated.

METHODS

A questionnaire survey on 12‑lead ECG recording and transmission was conducted in collaboration with the Fire and Disaster Management Agency of the Ministry of Internal Affairs and Communications, targeting all 723 fire departments in Japan in 2023. Official data released by each fire department were also evaluated.

RESULTS

Of 588 responding fire departments (81.3%), 545 (92.7%) had at least partial access to 12‑lead ECG recording equipment, whereas only 57 (9.7%) routinely utilized both recording and transmission. Multivariable logistic regression analysis indicated that routine 12‑lead ECG recording [odds ratio (OR) 2.88, 95% confidence interval (CI) 1.70-4.87; p < 0.001], the presence of acute coronary syndrome or chest pain protocols (OR 2.89, 95% CI 1.86-4.48; p < 0.001), the presence of 12‑lead ECG recording equipment in all ambulances (OR 0.54, 95% CI 0.36-0.81, p = 0.003), and time from emergency call to arrival at the scene (OR 1.15, 95% CI 1.01-1.31, p = 0.028) were significant factors for the introduction of 12‑lead ECG transmission systems. When comparing responding facilities in regions with a single percutaneous coronary intervention (PCI)-capable hospital within the medical control council (46 facilities) and those with ≥2 PCI-capable hospitals (405 facilities), the 12‑lead ECG transmission system introduction rate was significantly higher in single PCI-capable hospitals than in ≥2 PCI-capable hospitals (46% vs. 30%, respectively; p = 0.027).

CONCLUSIONS

Prehospital 12‑lead ECG recording equipment is widely available in Japan, but 12‑lead ECG transmission systems remain insufficiently implemented. The principal challenge is no longer equipment availability but establishing effective EMS-hospital communication pathways within regional STEMI networks.