Chest Pain? Dial 911, or Drive to Hospital?

Summarized by Robert W. Griffith, MD
April 8, 2004

Introduction

In America, a quarter of a million people die each year of a heart attack before they reach hospital. And it's well known that speedy medical care, such as clot-busting treatment (thrombolytic therapy), can save lives - if it's given in time.

We've tried to help make everyone aware of the various warning symptoms of a heart attack (MI, or myocardial infarction), but there's often an element of doubt in a person's mind: Should I call the doctor? Should I dial 911 (the US emergency call number)? Or should I drive, or be driven, to the Emergency Department?

Now there's an answer to these questions, thanks to a study by a group of US physicians reported in the American Heart Journal.

What was done

Information gathered from 20 US cities was used to determine the time between the onset of MI symptoms and contact with hospital-based emergency medical care. All patients with chest pain who arrived at a participating Emergency Department (ED) with acute chest discomfort were included in the analysis.

The periods between various time points were used to measure the speed with which appropriate treatment was accomplished. These time points were: the decision to seek help; arrival of the Emergency Medical Services (EMS) on the scene; arrival of the subject at the ED; and administration of thrombolytic therapy. For arrival at the ED, different periods were measured - for those using the EMS and for those using private transport.

What was found

Among 2400 eligible subjects, 35% used 911 and the EMS and 65% used private transportation. On average, private transport was somewhat faster - 35 minutes to the ED compared with 39 minute for the 911 calls.

But, if one considers EMS treatment to be the start of medical care, calling 911 was significantly more effective. The EMS arrived within an average of 6 minutes, while private transport to the ED averaged 32 minutes.¹

When patients arrived at the ED, the average time to starting thrombolytic therapy was 32 minutes for those brought in by the EMS, and 49 minutes for those coming by private transport.

Finally, the critical period from the decision to seek help to starting thrombolytic therapy (colorfully expressed as 'door-to-needle' time) confirmed that the 911 call was the best way to go; an average of 75 minutes with the 911-EMS approach, compared to 92 minutes with private transport.

What does this mean?

In general, only 50% to 60% of people with chest pain call 911 to get help. One of the main reasons people give for not calling is the belief that private transport will be quicker. They may indeed get to hospital faster by private car than by ambulance, but having the EMS on the scene in a short time (average 6 minutes in this study) allows earlier assessment, administration of oxygen and medications, if necessary.
One further point. With a family member doing the driving, a patient who becomes unconscious is far worse off than one in an ambulance with a trained health professional in attendance.

The conclusion is clear. If you or a loved one are experiencing symptoms suggestive of a heart attack (or a stroke, or any other medical emergency), call 911, or the emergency number appropriate for your country. You'll be much better off than getting the car out of the garage.

Source

• Patients with chest pain calling 9-1-1 or self-transporting to reach definitive care: Which mode is quicker? CB. Hutchings, NC. Mann, M. Daya,  et al., Am Heart J, 2004, vol. 147, pp. 35--41

Footnotes
1. This average time is different from that in the previous paragraph because different people were included in each analysis.

Related Links
When it's Important to Act in Time - Heart Attack
Women Should Know About Their Early Warning Signs of MI
What is Angina and Coronary Artery Disease?
Will You Have a Heart Attack as You Age?

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