Advanced Interventions During Prehospital Transport of Patients with Chest Pain and Suspected Acute Coronary Syndrome

Objective: The aim of this study is to describe the frequency and type of advanced (ALS) interventions performed by emergency medical services (EMS) providers while caring for undifferentiated chest pain patients. Methods: This pilot study is a retrospective review of advanced interventions performed on consecutive adult patients transported by EMS with a provider impression of non-traumatic chest pain and treated under the suspected acute coronary syndrome statewide protocol from July 2013 through January 2022. The EMS system studied is a hospital-based agency which serves a large suburban to rural population in central Pennsylvania. Advanced interventions were defined a priori and included STEMI activation. Results: During the study period, there were 2 456 EMS transports out of 97 877 which met study inclusion criteria. A total of 121 advanced interventions were performed on 101 (4.1%) of these patients, the majority 79 (3.2%) of which were prehospital notification of STEMI activations. Intravenous medications were administered 25 times to 22 (0.9%) patients and advanced procedures were performed 17 times on 7 (0.3%) patients. Several patients received more than one intervention and/or medication. Patients between 60 and 65 years of age accounted for the highest number of activations (283, 11.5%) and received the largest number of interventions (28, 9.9%). Only eight patients were below the age of 45 and all were STEMI activations only. Conclusion: We found that less than 5% of included patients transported by EMS required advanced interventions with the majority of these being STEMI activations not requiring any additional interventions. Further investigation is required to determine if certain characteristics or risk-factors predict the need for out-of-hospital advanced interventions and ALS transport.