Characteristics and outcome among patients who dial for the EMS due to chest pain

- Men and elderly were prioritized disproportionately low.
- The implementation of pre-hospital ECGs has failed.
- The emergency dispatcher failed to identify 1 in 4 potentially life threatening cases.
- The emergency dispatcher failed to give priority 1 to 1 in 3 whodied within 30 days.
- 1-year mortality in elderly (≥ 65 years of age) was almost 20%.
- CHD in the population using the EMS has decreased linearly since the 1980's.

ObjectivesThis study aims to describe patients who called for the emergency medical service (EMS) due to chest discomfort, in relation to gender and age.MethodsAll patients who called the emergency dispatch centre of western Sweden due to chest discomfort, between May 2009 and February 2010, were included. Initial evaluation, aetiology and outcome are described as recorded in the databases at the dispatch centre, the EMS systems and hospitals. Patients were divided into the following age groups: ≤ 50, 51-64 and ≥ 65 years.ResultsIn all, 14,454 cases were enrolled. Equal proportions of men (64%) and women (63%) were given dispatch priority 1. The EMS clinicians gave priority 1 more frequently to men (16% versus 12%) and older individuals (10%, 15% and 14%, respective of age group). Men had a significantly higher frequency of central chest pain (83% versus 81%); circulatory compromise (34% versus 31%); ECG signs of ischaemia (17% versus 11%); a preliminary diagnosis of acute coronary syndrome (40% versus 34%); a final diagnosis of acute myocardial infarction (14% versus 9%) and any potentially life-threatening condition (18% versus 12%). Individuals aged ≥ 65 years were given a lower priority than individuals aged 51-64 years, despite poorer characteristics and outcome. In all, 78% of cases with a potentially life-threatening condition and 67% of cases that died within 30 days of enrolment received dispatch priority 1. Mortality at one year was 1%, 4% and 18% in each individual age group.ConclusionMen and the elderly were given a disproportionately low priority by the EMS.