Prehospital incoming calls for Chest pain: Which factors do we need to prioritize the alarm?
Non traumatic chest pain (NTCP) is a common complaint to emergency medical control unit (EMCU). It overlies a wide spectrum of different etiologies, each requiring a specific therapeutic attitude. As such, the symptom analysis becomes delicate, particularly in a prehospital EMCU as variable clinical presentations might cover a single diagnosis and vice versa.
The aim of our study is to reveal the factors influencing the prioritization of incoming calls for a NTCP as well as indication for a medical transport.
Materials and methods: Our study is a transverse prospective survey accomplished at the EMCU of the emergent medical care service (EMCS) 03 of Sahloul University hospital, during a 2-months period running from January the 1st to February the 28th, 2017. It included all the incoming calls for NTCP from the Tunisian East-central area.
Data were collected via a form listing patient’s social and demographic characteristics, clinical features, EMCU praticians attitude and subsequent patient evolution. Statistical analysis was realized meaning SPSS 22.0 program.
Results: overall, 274 calls for NTCP were saved and 198 patients were included. The symptomatology was considered as vital functions-threatening (priority 1) in 40, 9%, and urgent (priority 2) in 28, 8% of cases. The decision to send a mobile emergency and resuscitation (MERU) was made in 71.3% but remained unenforceable in 16.2 % of cases because of technical means unavailability.
The elderly patients were usually assigned to priority 1 and 2 (prioritization 1 and 2: 64 +/- 14 years vs. prioritization 3 and 4: 58 +/- 18, 7 years, p=0, 01).
In contrast, neither gender nor aged conditioned prehospital medicalisation.
Among comorbidities, Diabetes was the single factor significantly associated to a higher MERU shipment (diabetic subjects 84, 4% vs. non diabetic ones 64%, p=0,009). Similarly, priorities 1 and 2 were more frequently attributed to diabetic individuals (diabetics 84, 4 % vs. 61, 5 %, p=0,004) and to smokers (smokers: 83, 3% vs. weaned smokers: 69% vs. lifelong nonsmokers: 60, 3%, p=0,045).
Heavy, retrosternal, epigastric, spontaneous/effort triggered as well as constrictive/burning chest pain were significantly associated to priorities 1 and 2, hence to MERU intervention. Similar facts were concluded for NTCP combined with ST segment elevation myocardial infarction revealed on initial ECG.
Conclusion: scrutinizing for cardiovascular risk factors and for functional signs is essential for determining the urgency level in the setting of an incoming call for a chest pain. Given few MERU available, regulation plays a substantial role in calls analysis and holds the key to a better resources management through a convenient detection of high-risk patients, therefore limiting interventions on fake emergencies.
