Too Many Heart Attack Victims Don't Call 911
July 10, 2000 -- There's no mistaking what doctors call a "Hollywood
heart attack" -- a man or woman clutches his or her chest and falls to the
But when the symptoms are jaw pain, dizziness, sweating, and nausea -- or
even mild chest and left arm pain -- many people either don't recognize that
they're in serious trouble or don't want to believe it. They don't call an
ambulance, and if they go to the emergency room, they are likely to drive
A survey in the July 11 issue of the journal Circulation reveals that
of nearly 900 people seen in the hospital for chest pain, only about 23% used
emergency medical service (EMS) transportation.
The combination of symptoms is confusing, says investigator N. Clay Mann,
PhD. "The person thinks, 'Oh, this will pass; this is indigestion.' Or 'I
just need to sit down for a while,'" he tells WebMD. Sometimes, too, people
are embarrassed or afraid of making the wrong decision, and so they don't call
for immediate help. People who took nitroglycerine, a commonly prescribed
medication for patients with heart disease, were more likely to call an
ambulance, leading Mann and his colleagues to believe that they were familiar
with the symptoms and so knew what to do.
The authors surveyed 20 communities across the U.S. and found that even when
people do realize they should go to the hospital, they still hesitate to call
911. Of those patients seen in emergency departments (EDs), about 60% had
someone drive them to the hospital. Nearly 16% actually drove themselves.
"What people are missing is that the moment those paramedics arrive on
their doorstep, treatment starts," says Mann, who is an associate professor
at the University of Utah School of Medicine in Salt Lake City. "Oxygen,
medications, monitoring, defibrillation [if their heart stops beating] ... are
available immediately. And probably the most important point is [the
paramedics] can call and warn the ED that [they're bringing in a person] with
chest symptoms, so care on arrival is much quicker."
The authors also did random telephone surveys with nearly 1,000 people in
the 20 communities and found that they were far more likely to call 911 for a
family member or even a stranger who appeared to be having a heart attack than
they would for themselves. This indicates that as bystanders, their intention
was to do the right thing. However, a limitation of this survey was that the
person answering the survey question was told the ill person was having a heart
attack. There was no guesswork about symptoms.
The most troubling finding was that using emergency medical services was
lower among people who called their doctors about their symptoms. Mann thinks
it's likely these people were falsely reassured. It may be that "the phone
call with the physician is reducing their anxiety to the point that they now
can drive themselves. Or, the other option is that the physicians feel ...
[that] they're well-versed in the patient's history, and they're saying, 'This
is your third angina [chest pain] attack. Why don't you have your wife drive
you in,'" Mann says. "I don't know which of those [possibilities] is
true, but the cold hard facts are that 83% who called their doctor and ended up
having a heart attack didn't call 911."