Source · HSSIB Patient Safety Investigation
12-lead electrocardiograms (ECGs) in ambulance services
Published 30 October 2025
Published
Emergency care
Cardiac
These two investigations will help to address patient safety risks associated with electrocardiogram (ECG) interpretation by ambulance crews in cases of ST Elevated Myocardial Infarction (StEMI).
Summary
1 recommendation
1 of 1 responded
Safety Recommendations
Recommendation 1
Department of Health and Social Care
HSSIB recommends that NHS England/Department of Health and Social Care reviews and amends the service specification for primary percutaneous coronary intervention (PPCI) centres, to include a requirement for a function enabling two-way communication with ambulance crews for shared decision making about patients with a suspected STEMI. This is to ensure that patients are taken to the correct place of care and PPCI teams are responding to confirmed STEMI cases.
NHS England will issue a communication reminding of existing two-way communication requirements by January 2026 and formally revise the PPCI service specification to include the recommended function by March 2028, subject to resources.
Response received 2 February 2026
Summary response: The published PPCI service specification (A09/S/d - https://www.england.nhs.uk/wp-content/uploads/2018/08/Cardiology-primary-percutaneous-cortonary-intervention-adult.pdf is due to be reviewed by the cardiac services clinical reference group (subject to resources) within the next 18-24 months. Communication between the ambulance service and the heart attack centres is already included as a requirement within the existing service specification, however, we agree that the requirement should be updated in line with HSSIB's recommendation. It is important however that there is onus on both the ambulance services and PPCI centres so that paramedic crews have the appropriate equipment and training to enable 2-way communication. NHS England will send a communication to regional commissioning teams and commissioned providers to remind them of the existing requirements within the published PPCI specification with regards to 2-way communications with ambulance services. NHSE accepts this recommendation and will include as part of the revision of the service specification. Actions planned to deliver safety recommendation: NHS England will send a communication to regional commissioning teams and commissioned providers to remind them of the existing requirements within the published PPCI specification with regards to 2 way communications with ambulance services, by 29 January 2026. Revise the published PPCI service specification in line with NHS England’s national methods process: https://www.england.nhs.uk/wp-content/uploads/2018/08/Cardiology-primary-percutaneous-cortonary-intervention-adult.pdf , by March 2028. Additional information: To be included within 26/27 cardiac services clinical reference group workplan (subject to resources). Response received on 2 February 2026.