Amendment to the Ohio EMS scope of practice regarding acquisition of EKGs

Acute ST-segment myocardial infarction (STEMI) is a time-sensitive diagnosis for which emergent intervention is a critical factor in the reduction of mortality and morbidity associated with heart disease. The rapid acquisition of a multi-lead EKG is a key element in the identification of patients who have sustained an acute STEMI.

Since the promulgation of the Ohio Administrative Code (OAC) regulations regarding the acquisition of EKGs, the equipment to perform EKGs that is now available to Ohio EMS agencies has advanced. Specifically, the equipment to perform out-of-hospital EKGs to identify acute STEMIs that involve the posterior wall and/or the right ventricle during the initial EKG acquisition, e.g., 15-lead EKGs, are now readily available to Ohio EMS agencies. The additional information gleaned from these EKGs can impact the care provided to the patient by EMS and potentially improve patient outcomes.

On April 16, 2025, the State Board of Emergency Medical, Fire, and Transportation Services (EMFTS Board) approved amending the regulatory language in the Ohio Administrative Code from "12-lead EKG" to "diagnostic EKG" in all areas where it is cited in OAC 4765. Specifically, this amendment will be made in OAC 4765-15-04(B)(19), OAC 4765-16-04(B)(11), and OAC 4765-17-03(A)(15). This amendment will permit the acquisition of EKGs to diagnose STEMIs with all of the modes of technology available to complete this task. It will also remove any potential conflict with the manufacturer's recommendations for the EKG acquisition device.

Analogous to all services, the EMS medical director must authorize the performance of diagnostic EKG acquisition and provide a written protocol for this service. The EMS medical director must also provide training, continuing education, and a quality assurance process for the acquisition of diagnostic EKGs and should comply with the manufacturer's recommendations for the device utilized.

As a result of the EMFTS Board's action today, this amendment in the Ohio EMS scope of practice is effective immediately. If you have any questions, please contact me or our staff at the Ohio Department of Public Safety, Division of EMS at (800) 233-0785.

Thank you for your dedicated service to Ohio EMS!