A lot of places have updated their curriculum or clinical guidance documents. Medicine is a slow moving beast, however, so change takes forever. A lot of AHA recommendations are woefully outdated. But everyone keeps doing the same thing because they are scared to not do what AHA recommends. I have 15 years as a medic, with 5 being as a training officer for a large capital city metro EMS system. Our clinical guidelines were probably updated 2017-18 with new placement guidance to start placing pads anterior-posterior. At first it was to facilitate automated CPR devices (Lucas) and CPR feedback puck placement. We noticed better resuscitation results, even when considering the CPR devices. Our medical director is extremely progressive and some short research later and consulting with Zoll, we moved to anterior posterior.
If you think of the traveling electrical power as a vector (pointing arrow), consider Anterior-Anterior vs Anterior-Posterior and draw a vector (arrow) between the pads. Which placement directs most of the power to the tissue of the heart? Anterior-Posterior does as the arrow goes directly through the ventricles, the area responsible for the VF/VT rhythm generation.
Once I learned how monitors, specifically Zoll, do rhythm analysis, and especially Zoll's Shock Conversion Estimator, I moved on and went back to school for engineering to help design products like these. It is all really cool stuff.
Zolls aren't any better. I managed a fleet of 70+ X-Series Advanced, and only read normal on young adults who were perfectly still and electrodes were placed perfectly. That being said, the rhythm and 12 lead interp algo on it was impressively accurate. It would very often pick up subtle very high lateral infarcts, usually only identified by clinicians familiar with the "south african flag sign."
HIPAA allows us (I'm a medic) to broadcast patient information for treatment related purposes. It's useful for us and hospitals because they can pre-register time sensitive patients and pull up history/previous test that can be extremely important for STEMIs/strokes/etc.
If you think of the traveling electrical power as a vector (pointing arrow), consider Anterior-Anterior vs Anterior-Posterior and draw a vector (arrow) between the pads. Which placement directs most of the power to the tissue of the heart? Anterior-Posterior does as the arrow goes directly through the ventricles, the area responsible for the VF/VT rhythm generation.
Once I learned how monitors, specifically Zoll, do rhythm analysis, and especially Zoll's Shock Conversion Estimator, I moved on and went back to school for engineering to help design products like these. It is all really cool stuff.