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(Circulation. 2000;102:173.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Demographic, Belief, and Situational Factors Influencing the Decision to Utilize Emergency Medical Services Among Chest Pain Patients

Adam L. Brown, BS; N. Clay Mann, PhD, MS; Mohamud Daya, MD, MS; Robert Goldberg, PhD; Hendrika Meischke, PhD; Judy Taylor, EDD; Kevin Smith, MA; Stavroula Osganian, MD; Lawton Cooper, MD; for the Rapid Early Action for Coronary Treatment (REACT) Study

From the Department of Emergency Medicine, Oregon Health Sciences University, Portland (A.L.B., N.C.M., M.D.); the Intermountain Injury Control Research Center, University of Utah School of Medicine, Salt Lake City (N.C.M.); the Department of Cardiology, University of Massachusetts School of Medicine, Worcester (R.G.); the Department of Health Services, University of Washington, Seattle (H.M.); the Division of Health and Kinesiology, Mississippi University for Women, Columbus (J.T.); New England Research Institutes, Watertown, Mass (K.S., S.O.); and the National Heart, Lung, and Blood Institute, Bethesda, Md (L.C.).

Correspondence to N. Clay Mann, PhD, MS, Intermountain Injury Control Research Center, 410 Chipeta Way, Suite 222, Salt Lake City, UT 84108-1226. E-mail: clay.mann{at}hsc.utah.edu

Background—Empirical evidence suggests that people value emergency medical services (EMS) but that they may not use the service when experiencing chest pain. This study evaluates this phenomenon and the factors associated with the failure to use EMS during a potential cardiac event.

Methods and Results—Baseline data were gathered from a randomized, controlled community trial (REACT) that was conducted in 20 US communities. A random-digit-dial survey documented bystander intentions to use EMS for cardiac symptoms in each community. An emergency department surveillance system documented the mode of transport among chest pain patients in each community and collected ancillary data, including situational factors surrounding the chest pain event. Logistic regression identified factors associated with failure to use EMS. A total of 962 community members responded to the phone survey, and data were collected on 875 chest pain emergency department arrivals. The mean proportion of community members intending to use EMS during a witnessed cardiac event was 89%; the mean proportion of patients observed using the service was 23%, with significant geographic differences (range, 10% to 48% use). After controlling for covariates, non-EMS users were more likely to try antacids/aspirin and call a doctor and were less likely to subscribe to (or participate in) an EMS prepayment plan.

Conclusions—The results of this study indicate that indecision, self-treatment, physician contact, and financial concerns may undermine a chest pain patient’s intention to use EMS.

Key Words: coronary disease • epidemiology • public policy

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