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Reasons Prehospital Personnel Do Not Administer Aspirin to All Patients Complaining of Chest Pain

Published online by Cambridge University Press:  28 June 2012

Edmond A. Hooker*
Affiliation:
Department of Health Services Administration, Xavier University, Cincinnati, Ohio, USA Department of Emergency Medicine, University of Louisville, School of Medicine, Louisville, Kentucky, USA
Taylor Benoit
Affiliation:
Department of Emergency Medicine, University of Louisville, School of Medicine, Louisville, Kentucky, USA
Timothy G. Price
Affiliation:
Department of Emergency Medicine, University of Louisville, School of Medicine, Louisville, Kentucky, USA
*
Edmond A. Hooker, MD Department of Health Services Administration Xavier University 3800 Victory Parkway Cincinnati, Ohio 45207-7331 USA E-mail: ehooker@fuse.net

Abstract

Introduction:

Aspirin is administered to patients with acute coronary syndromes (ACSs), but prehospital providers do not administer aspirin to all patients with chest pain that could be secondary to an ACS.

Objective:

To identify reasons prehospital providers fail to administer aspirin to all patients complaining of chest pain.

Methods:

A convenience sample of prehospital providers was surveyed as they transported patients with a chief complaint of chest pain to the emergency department. The providers were asked if they had given aspirin, nitroglycerin, or oxygen, or if they utilized a monitor. If the medications had not been administered, the paramedic was asked about the reason. The patient's age and previous cardiac history also was recorded.

Results:

A total of 52 patients with chest pain who were transported were identified over eight weeks, and all of the providers agreed to participate in the study. Only 13 of the patients (25%) received aspirin. Reasons given for not administering aspirin to the other 39 patients included: (1) chest pain was not felt to be cardiac in 13 patients (33%); (2) 10 patients already had taken aspirin that day (26%); (3) the medical provider was a basic-level emergency medical technician (EMT)-Basic and could not administer aspirin to six patients (15%); (4) pain subsided prior to arrival of emergency medical services (EMS) in these three patients; and (5) other reasons were provided for the remaining seven patients.

Conclusions:

The most common reason that paramedics did not administer aspirin was the paramedic's belief that the chest pain was not of a cardiac nature. Another common reason for not giving aspirin was the inability of EMT-Basic providers to administer aspirin.

Type
Original Research
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2006

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References

1Second International Study of Infarct Survival Collaborative Group: Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction. ISIS-2. Lancet 19882(8607), 349360.Google Scholar
2Eisenberg, MJ, Topal, EJ: Prehospital administration of aspirin in patients with unstable angina and acute myocardial infarction. Arch Intern Med 1996;156, (14), 15061510.CrossRefGoogle ScholarPubMed
3Freimark, D, Matetzky, S, Leor, J, et al. : Timing of aspirin administration as a determinant of survival of patients with acute myocardial infarction treated with thrombolysis. Am J Cardiol 2002;89(4):381385.CrossRefGoogle ScholarPubMed
4Quan, D, LoVecchio, F, Clark, B, Gallagher, JV: Prehospital use of aspirin rarely is associated with adverse events. Prehosp Disast Med 2004;19(4):362365.Google Scholar
5Snider, JB, Moreno, R, Fuller, DJ, Schmidt, TA: The effect of simple interventions on paramedic aspirin administration rates. Prehosp Emerg Care 2004;8(1):4145.CrossRefGoogle ScholarPubMed
6Rothrock, SG, Brandt, P, Godfrey, B, et al. : Is there gender bias in the prehospital management of patients with acute chest pain? Prehosp Emerg Care 2001;5(4):331334.Google Scholar
7Woollard, M, Smith, A, Elwood, P: Prehospital aspirin for suspected myocar-dial infarction and acute coronary syndromes: A headache for paramedics? Emerg Med J 2001;18(6):478481.Google Scholar
8Stoykova, B, Dowie, R, Bastow, P, et al. : Ambulance emergency services for patients with coronary heart disease in Lancashire: Achieving standards and improving performance. Emerg Med J 2004;21(1):99104.CrossRefGoogle ScholarPubMed
9Rittenberger, JC, Beck, PW, Paris, PM: Errors of omission in the treatment of prehospital chest pain patients. Prehosp Emerg Care 2005;9(1):27.Google Scholar
10Funk, D, Groat, C., Verdile, VP: Education of paramedics regarding aspirin use. Prehosp Emerg Care 2000;4(1):6263.CrossRefGoogle ScholarPubMed
11Schaider, JJ, Riccio, JC, Rydman, RJ, Pons, PT: Paramedic diagnostic accuracy for patients complaining of chest pain or shortness of breath. Prehosp Disast Med 1995;10(4):245250.Google Scholar
12Summers, RL, Cooper, GJ, Carlton, FB, et al. : Prevalence of atypical chest pain descriptions in a population from the southern United States. Am J Med Sci 1999;318(3)142145.Google Scholar
13Summers, RL, Cooper, GJ, Woodward, LH, Finerty, L: Association of atypical chest pain presentations by African Americans and the lack of utilization of reperfusion therapy. Ethn Dis 2001;11(3):463468.Google Scholar
14Haynes, BE, Pritting, J: A rural emergency medical technician with selected advanced skills. Prehosp Emerg Care 1999;3(4):343–.Google Scholar
15Murata, GH: Evaluating chest pain in the emergency department. West J Med 1993;159(1)6168.Google ScholarPubMed
16Kohn, LT, Corrigan, JM, Donaldson, MS, (eds): To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press; 2000.Google Scholar
17Fourth International Study of Infarct Survival Collaborative Group: ISIS-4: A randomised factorial trial assessing early oral captopril, oral mononitrate, and intravenous magnesium sulphate in 58,050 patients with suspected acute myocardial infarction. Lancet 1995;345(8951), 669685.Google Scholar