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9-1-1 Caller-Described Heart Attack Symptoms

Greg Scott1, Christopher Olola1, Matthew Miko1

  • 1International Academies of Emergency Dispatch, Salt Lake City, Utah, USA.

Prehospital and Disaster Medicine
|July 18, 2022
PubMed

Insights

Emergency Medical Dispatchers often use the chest pain/discomfort protocol for heart attacks (HAs). However, callers frequently describe HA symptoms beyond chest pain, highlighting the need for dispatcher training in symptom clarification.

Area of Science:

  • Emergency Medical Services
  • Cardiology
  • Public Health

Background:

  • Heart attacks (HAs) can present with diverse symptoms, not always classic chest pain (CP) or chest discomfort (CD).
  • Emergency Medical Dispatchers (EMDs) utilize the CP/CD protocol for various HA presentations, but the frequency of non-CP/CD symptom reporting is unclear.

Purpose of the Study:

  • To analyze caller descriptions of primary and secondary heart attack (HA) symptoms.
  • To evaluate the utilization of a case entry (CE) question clarifier by Emergency Medical Dispatchers (EMDs).

Main Methods:

  • Retrospective analysis of 1,261 randomly selected Emergency Medical Dispatcher (EMD) audio recordings from US emergency communication centers.
  • Quality Performance Review (QPR) experts documented initial caller problem descriptions, CE clarifier use, and EMD-assigned determinant codes.

Main Results:

  • The case entry (CE) clarifier was used in only 8.5% of reviewed heart attack (HA) calls.
  • Chest pain/discomfort (CP/CD) symptoms were reported in 87.0% of cases, either alone or with other issues.
  • CP alone was the most frequent symptom (70.8%), with HA alone (4.0%) and CD alone (1.4%) being less common.

Conclusions:

  • Callers describe potential heart attacks (HAs) using varied terminology, with chest pain (CP) being most common.
  • Less frequent HA symptoms may be underreported or missed.
  • EMDs require enhanced training to effectively use clarifying questions for initial "heart attack" complaints to elicit comprehensive symptom information.
Abstract

Keywords:
cardiovascular diseaseschest discomfortchest painheart attack symptomsmyocardial infarction

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