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In Case Of Heart Attack, Should You Call 911 or Drive to Hospital?

December 23, 2003 — People experiencing chest pain are better off calling 911 and using emergency medical services (EMS) than driving to a hospital, according to a recent study by researchers from the University of Utah medical school and five other institutions.

Research findings show that on average, private transportation resulted in faster arrival (35 minutes) to an emergency department compared with transport via ambulance (39 minutes), but the latter resulted in faster medical treatment.

“People experiencing chest pain often do not consider that life-saving measures can be initiated as soon as EMS arrives. Also, EMS personnel can warn hospital personnel about a person’s symptoms, shortening the time needed to diagnose and provide necessary treatment once the patient arrives at the hospital,” said N. Clay Mann, Ph.D., M.S., principal investigator and a researcher at the Intermountain Injury Control Research Center, a part of the University of Utah School of Medicine’s Department of Pediatrics. Study results will appear in the January issue of the American Heart Journal.

Every year, about 1.2 million Americans experience acute myocardial infarction (AMI) or heart attack, with more than half dying before getting appropriate medical care. Thrombolytic medications, which break clots that block arteries during AMI, can reduce deaths significantly if given within an hour of the onset of symptoms.

Although previous studies have shown that using EMS allows for quick delivery of thrombolytic therapy, only 50-60 percent of persons suffering chest pain chose to use EMS because most patients thought driving directly to the hospital was quicker than calling 911.

Previous studies were largely limited in scope, so Mann’s research team used data from 20 U.S. communities to demonstrate that the time savings from utilizing EMS were universal, regardless of any particulars associated with any city or EMS system.

Data came from 5,581 respondents included in the Rapid Early Action for Coronary Treatment (REACT) trial, a national project designed to evaluate the effects of community intervention on the time interval between onset of AMI symptoms and hospital emergency care.

The study involved review of medical records and a follow-up telephone survey. Researchers compared elapsed time intervals from the decision to seek care to actual initial care.

“Chest patients who utilize private transportation to get to the ED faster may actually be delaying treatment,” the study concluded. It recommended educating the public about the advantages of EMS care and transport in case of a heart attack.

Mann did most of his work for this study while he was a faculty member of the Department of Emergency Medicine at the Oregon Health Sciences University (OHSU). The other investigators are: Caroline B. Hutchings, M. Stat., U Intermountain Injury Control Research Center; Mohamud Daya, M.D., M.S., OHSU Department of Emergency Medicine; Jon Jui, M.D., M.P.H., OHSU Department of Emergency Medicine; Robert Goldberg, Ph.D., Department of Cardiology, University of Massachusetts Medical School; Lawton Cooper, M.D., M.P.H., National Heart, Lung, and Blood Institute; David C. Goff Jr., M.D., Ph.D., Public Health Sciences and Internal Medicine, Wake Forest University School of Medicine; and Carol Cornell, Ph.D., School of Medicine, University of Alabama at Birmingham.