Why don’t they call? There is a general consensus in emergency medicine the sooner thrombolytic (clot busters) therapy can be administered after the onset of symptoms, the greater the reduction in heart damage. This is based on current research which suggests “clot buster” therapy in patients with suspected acute coronary thrombosis reduces mortality after heart attacks. As out-of-hospital care providers, we understand the implications of delaying hospital care. Why don’t they call 911 earlier?
A study recently published addresses this question. It looked at 5,206 patients admitted to CCU or ICU in nine hospitals with suspected MI(heart attack) occurring outside of the hospital. For deceased patients, the next of kin was contacted. Of the possible 5,206 patients, 2,317 were interviewed to assess the use of EMS and determine the circumstances leading to hospitalization and on delays in obtaining assistance.
Persons who delayed getting help for more than 20 minutes were asked why they delayed seeking help. The results were placed in nine categories: thought symptoms would go away, not severe enough, worried about the cost, fear of hospitals, fear of being embarrassed, wait for a better time, did not want to know what was wrong, and other; who knows what other is, maybe to cook dinner! These people were also asked if they or someone else had called 911 before leaving for the hospital. The ones who had not were ask why.
Average time delay between symptom onset and hospital arrival was two hours, a high to 23% delayed more than six hours. Of the interviewed patients, 1,192, over half, had not called 911 before hospitalization. Characteristics differ significantly for callers and non callers. Persons who had not used the EMS system had a higher education than those who had called 911, non-callers were younger than callers. Fewer non-callers reported a history of chest pain or history of MI; were less likely to have been diagnosed with an MI or were less likely to have been diagnosed with an MI during the event that led to the hospitalization.
It is determined in the study that the main obstacle in delay appears to be uncertainty interpreting MI symptoms. Most reported they were not sure the symptoms the had were severe enough to merit such drastic action–like calling 911. This study sheds light on behavior during a heart emergency. Analysis of a person’s behavior shows that people are generally confused about how to interpret their symptoms. It is not clear if this confusion stems from a lack of knowledge about MI symptoms or a lack of confidence in the provider’s ability to assess accurately and treat the patient appropriately.
On way to shorten out-of-hospital delay is to encourage persons with heart-related symptoms to call EMS for hospital transport rather than use slower transportation methods. For patients who have MI symptoms, not only is ambulance transport often the quickest method, but paramedics can initiate supportive care, including oxygen, pain medication, and heart drugs. Other studies have shown that patients brought to a hospital by ambulance with MI symptoms receive thrombolytics sooner than patients who arrive by other methods.
If you have any questions about what your symptoms may or may not be do not hesitate to call the nearest EMS. We are lucky in Brinkley and Monroe County to have 911. CALL, do not wait, remember your life may depend on it.