You are relaxing or doing some activity at home. Suddenly, you experience chest pain and shortness of breath. What is your immediate reaction? Dial 911 and call an ambulance? Get in your car and drive yourself to emergency department (ER)? Have a family member drive you to ER? Or pop some antacid pills in your mouth and wait?
Well, while you are scratching your head for an answer, let us ask the question to Dr. Hal Canham, ER Physician at Medicine Hat Regional Hospital (MHRH) and Medical Director of Medicine Hat Ambulance Service.
As a physician, I may be able to judge if my chest pain is of cardiac (heart) or non-cardiac origin. If I am not sure, then I will dial 911 and ask for an ambulance. My advice to people in general is to call 911 immediately if they experience chest pain. There may not be time for self-diagnosis, says Dr. Canham.
Each year, close to half a million people in Canada come to ER with chest pain. Some have acute life threatening illness. Others may have nothing seriously wrong with them. Some may have history of coronary heart disease. Others may not.
What about Medicine Hat?
In an 18 month period (June/97 to Dec/98), the ER Department at MHRH sees 53,548 patients. Out of these, 50 patients are confirmed to have heart attack and are eligible for thrombolytic (clot busting) therapy.
Dr. Canham studied these 50 cases. What did he find? A major concern became apparent immediately. Of the 50 patients with diagnosis of heart attack, only 15 had called for an ambulance! This confirmed our impression that there is underutilization of the ambulance service for chest pain patients in our community.
Why call an ambulance? Isnt it faster for me to jump in my car and rush to ER?
If your chest pain is due to heart attack then the outcome of your illness may be dictated by: 1) the speed and mode of transportation to ER, 2) your previous history of cardiac problems, 3) rapid evaluation of your condition by ER physician, 4) the use of clot busting drugs in a timely fashion.
In 1997, the Medicine Hat Ambulance Service purchased new cardiac monitors and defibrillators. The aim is to speed up the delivery of clot busting drug to eligible cardiac patients.
Our paramedics are now able to do 12-lead cardiac monitoring in patients own home immediately on arrival. This test is transmitted live to ER physician to diagnose heart attack before the patient arrives. The ER physician is then ready with clot busting drug if the diagnoses are confirmed.
There is also another important reason to call 911. Early in the course of a heart attack, patients are at risk of having the heart stop (cardiac arrest). The chance of surviving this is better in an ambulance with paramedics at hand then in your own vehicle.
Dr. Canham, what is your message to the people of our region?
The Medicine Hat Ambulance Service is truly an extension of our ER Department and rarely is this more apparent then when you are experiencing chest pain or shortness of breath. Be aware of symptoms suggestive of a heart attack and call 911 early!
Pain is the most frequent presenting symptom. It is deep in the chest, described as heavy, squeezing, and crushing. The pain may radiate to the neck or the arms. There may be weakness, sweating, vomiting or giddiness. Symptoms may vary. So do not waste time on self-diagnoses. One telephone call may save your life!
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