Mandatory ECG for Paediatric Syncope - MEPS

ECG’s acquired when a child faints provide lifesaving data

Every Paramedic in Ontario, and probably where you live, is trained and equipped to take an ECG (Electrocardigram) and do basic heart rhythm interpretation. When Paramedics respond to a call for a child that has fainted it should be mandatory to get an ECG and to provide the strip to the Doctors in the ER, even if upon arrival at the scene the child has regained consciousness and “seems” fine.

Of the 700 young people that die suddenly of cardiac arrest each year in Canada about half had a fainting episode in the days, weeks, months or years prior to their death. These sentinel events provide the best opportunity to identify an underlying heart rhythm disorder and initiate treatment and prevention therapies.

Important information about what was happening to the child’s heart at the time of collapse is lost as time passes. The sooner the first or "presenting" ECG is taken the greater the understanding that Doctor’s will have of what triggered the event.  As time passes the heart returns to baseline and important clues may be lost.  

It is not essential for Paramedics to interpret these early ECG’s, they simply have to acquire the strip. Once acquired the ECG strip can be shared with the physicians in the ER or the Paediatric Cardiologists for analysis. Once acquired the ECG becomes part of the electronic call record and can be accessed weeks, months or even years later perhaps making an important contribution to a future investigation.

Studies estimate that roughly 1 in 20, about 5%, of all childhood faints are a warning sign for an underlying heart rhythm disorder. For faints occurring during or shortly after physical activity, while swimming or as a result of a loud unexpected noise (auditory startle) that number may go as high as 1 in 3, or 33%. Building communities that are more sensitive and responsive to childhood fainting can only result in young lives being saved.

There are some questions around the ability of Paramedics and the equipment they work with to collect accurate ECG’s from prepubescent patients. Two things occur to me - first, get the strip and let the physicians decide if it contains useful information – second, perform more ECG’s on children and get better at it which may also require additional training and equipment software upgrades with better paediatric programs.  As taxpayers we are paying for our Paramedics to be equipped and trained to gather ECG data, this toolkit has its greatest potential value when it is applied to our children.

Currently at least 14 states and provinces have legislation passed or pending designed to increase sensitivity to the warning signs of paediatric heart rhythm disorders in our communities. If Teachers and Coaches call 9-1-1 every time a child faints and Paramedics acquire an ECG for every child that faints and ER Doctors do a thorough work-up including event history, patient history and family history (and consults with appropriate specialists when required) for every child that faints, many young lives will be saved.

When a youngster has one or more fainting episodes and then dies an opportunity to save that child’s life has likely been missed. I have listened to the stories from dozens of families that have lost children to sudden cardiac arrest and far too many of those stories include anecdotes of fainting episodes that educators, sport officials and most concerning healthcare professionals have overlooked, brushed off or misdiagnosed.  Paramedics and the EMS system can play a vital role in ensuring that potentially lifesaving information is recognized and acted upon whenever our children experience a loss of consciousness faint.