Patients with chest pain calling 9-1-1 or self-transporting to reach definitive care: which mode is quicker?☆☆☆
Received 5 February 2003; accepted 18 June 2003.
Abstract
Objective
We examined differences in transport times for patients with chest pain who used private transportation compared with patients who used emergency medical services (EMS) to reach definitive medical care.
Methods
This was a retrospective cohort study with data used from the Rapid Early Action for Coronary Treatment (REACT) trial conducted in 20 US cities. Elapsed time to care was examined through the use of (1) decision to seek care to initial care (emergency department [ED] arrival versus EMS arrival on scene [n=1209]); (2) decision to ED arrival (for both groups [n=2388]); (3) time to thrombolytic therapy once admitted to the ED (for both groups [n=309]); and (4) decision to seek care to thrombolytic therapy (n=276). Elapsed travel times were ranked within Zip Codes and submitted to a nested analysis of variance model to determine if elapsed times were different between modes of transport.
Results
Private transportation (35 minutes) resulted in faster ED arrival than using EMS (39 minutes, P = .0014). However, if one considers EMS treatment to be initial care, calling 9-1-1 (6 minutes) resulted in much quicker care than patients using private transportation to the ED (32 minutes, P < .001). Transport by EMS resulted in a shorter elapsed time to thrombolytic administration compared with patients using private transportation when considering ED “door-to-needle” time (32 vs 49 minutes, respectively [P < .001]) or time from decision to seek care until administration of thrombolytic therapy (75 vs 92 minutes, respectively, [P = .042]).
Conclusions
Although private transportation results in a faster trip to the ED, quicker care is obtained with the use of EMS.
aIntermountain Injury Control Research Center, University of Utah School of Medicine, Salt Lake City, Utah, USA
bDepartment of Emergency Medicine, Oregon Health Sciences University, Portland, Ore, USA
cDepartment of Cardiology, University of Massachusetts Medical School, Worcester, Mass, USA
dNational Heart, Lung, and Blood Institute, Washington, DC, USA
ePublic Health Sciences and Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
fSchool of Medicine, University of Alabama at Birmingham, Birmingham, Ala, USA
Reprint requests: N. Clay Mann, PhD, MS, Intermountain Injury Control Research Center, 615 Arapeen Drive, Suite 202, Salt Lake City, Utah 84108-1284, USA.
☆ Supported by cooperative agreements U01-HL-53141, U01-HL-53412, U01-HL-53149, U01-HL-53155, U01-HL-53211, and U01-HL-53135 from the National Heart, Lung, and Blood Institute, Bethesda, Md.
☆☆ The authors are solely responsible for the content of the article, and the opinions do not necessarily represent the views of any listed funding source.
ABSTRACT