I manage an ambulance company with about 70 ALS vehicles doing primary 9-1-1 work. We recently upgraded our cardiac monitors from the Zoll E-Series to the X-Series and are having some significant problems. Our issues mostly center around the new 12-lead interpretion algorithm. The X-Series requires a MUCH cleaner 12-lead before it will do the interpretation. As a result we are seeing about a third of our 12-leads not being interpretted due to data quality limitations. We never had this problem with the E-Series monitors and nothing has changed with our process other than the monitors. Also, the E-Series gace a clear *** Acute MI*** readout that was used for cath lab activation. The X-Series provides ***STEMI*** which does not correlate to the E-Series. That part is hard for me to explain, but if you're familiar with both monitors, you know what I mean. For those of you with X-Series monitors, what are you using for cath lab activation triggers? I'm sure some of you are going to say that we should just train our medics to read the 12-lead, but there is no support for that in our community. In fact, a review of more than 100 12-leads interpretted by our old E-Series monitors showed the monitor interprettation to be more reliable than that of most ER docs. Enough of my ramblings... please use this as a general thread to discuss issues with the transition from E-Series to X-Series monitors.