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The 12‐lead ECG remains the quickest method of detecting myocardial ischemia or infarction. Although ECGs have been used to diagnose ACS since 1932, the technology has now advanced to the point that a prehospital ECG can be done quickly and accurately and can be sent wirelessly to the receiving hospital at a relatively low cost. Additional benefit can be gained by having the prehospital ECG become the first of a series of ECGs, increasing the sensitivity of diagnosis of coronary syndromes [18].

Performing a prehospital ECG on a patient exhibiting signs and symptoms of ACS is a Class I AHA/ACC recommendation [15, 16]. This recommendation is based on evidence demonstrating that, despite minimal increased time spent on scene for patients receiving ECGs, the time to definitive treatment for ST‐elevation myocardial infarction (STEMI) with fibrinolysis or percutaneous coronary intervention (PCI) is shortened overall, with a significant reduction in mortality [19].