Practitioner perspectives on Sex and Gender Equity in Pre-hospital Electrocardiogram Acquisition

Aman Hussain, Neil McDonald, Nicola Little, Erin Weldon

Introduction: Acute Coronary Syndrome (ACS) remains a substantial healthcare burden. Previous research has demonstrated that women fare worse than men across a range of hospital-based ACS processes and outcomes. In the prehospital setting, the 12-lead electrocardiogram (ECG) can identify critical ACS cases and speed access to definitive treatment. However, studies on rates of ECG acquisition among patients at risk of ACS in the prehospital setting have shown that women receive the test less frequently than men. 

Objective: The purpose of this study is to investigate the reasons for observed gender differences in rates of ECG acquisition in the prehospital setting. 

Methods: This was a qualitative study of frontline paramedics in a mid-size Canadian city. Semi-structured interviews were conducted via Zoom. All interviews were scheduled for 40 minutes but were allowed to end naturally. Interviews were then professionally transcribed and shared with the research team. Reflexive thematic analysis was utilised to analyse the interview data to interpret findings. Rigour was addressed by frequent meetings amongst the research team, consistently revisiting and reviewing the data, and discussing our mutual interpretations.

Findings: Twenty-six (n=26) paramedics participated in the interviews. A number of specific barriers to ECG acquisition among women were identified and grouped into themes. These included: discomfort / hesitancy on the part of the patient or paramedic to exposing a woman’s chest (theme of safety); variable knowledge about sex and gender differences in presenting symptoms and risk factors for ACS (knowledge); inconsistent or absent gender-specific training in ECG acquisition and varied field experiences (training and learning); and diverse views on how behaviours and attitudes influence the conduct of the procedure (professionalism). Collectively, these four interrelated themes were integrated to represent a model of prehospital cardiac care.

Conclusions: This study filled a knowledge gap by documenting prehospital providers’ attitudes and beliefs around cardiac care. The model of prehospital cardiac care can provide a framework for evaluation and guide professional development. Further research is required to investigate gender-specific training and the utility of the model of prehospital care.