When it comes to 12 lead EKG's I've been known to belittle the things, not because they are not worthy tools, and indispensable in the field, rather because once at the ER my interpertation of them is often ignored or barely recognized.
That is the ER reality. More important than that, however, is the reality in the rescue, where there is no cath lab, no cardiac resident, no specialists-just you, the patient and your partner. There, the importance of the interpretation of the 12-lead cannot be understated. The presentation of the patient will only tell us so much, and most of us can recognize a person in trouble, it's the tools at our disposal and how we use them that separates the good medics from the not so good ones.
Our chest pain protocol calls for oxygen, nitro, aspirin, a 12-lead, IV and transport. There are contra-indications and all that, but those simple things will get you by, and probably won't harm the patient and actually do him some good. What is essential, however, is not written in the protocols, rather learned through experience. Things like doing the 12-lead prior to administering nitro, asa and o2, if prudent. The seemingly insignifigant interventions can make an enormous difference in the 12 lead interpretation and the treatment plan to follow.
It's good for the patient, and kind of nice at the triage desk, when your fine work is about to be disregarded to mention that the 12-lead that is about to be ignored was done prior to interventions, and should be used as a comparison at the very least.