Gender and two NBTs can help predict PCS after MHI.

No abstract

Abstract. Objective: To assess whether contact with a health care provider or gatekeeper increases the use of a n ambulance for patients with acute chest pain. Methods: A convenience sample of adults 240 years of age presenting with a chief complaint of chest pain were interviewed by trained personnel regarding transport used to come to the ED. The study was performed at the ED of a n urban university hospital. Patients with hemodynamic instability and those receiving thrombolytics or emergency angioplasty were excluded. Patients were asked about access to a primary health care provider and contact with a provider regarding this ED visit, including instructions given for transportation. Results: Of the 450 interviewed patients, 42% arrived by ambulance. Those who had contact with a health care provider prior to the ED visit were less likely to come by ambulance than those without contact, 31% vs 51% (p < 0.001). Of the patients who had cardiac enzymes obtained to work up for their chest pain, 34% with health provider contact vs 57% without health pro-' vider contact arrived by ambulance (p c 0.001). Of those with acute myocardial infarction, 30% with health provider contact vs 66% without health provider contact came by ambulance (p < 0.03). Patients who recalled transport instructions from their providers tended to follow those instructions. The majority of patients who recalled no specific transport instructions arrived by personal automobile. Conclusion: Of patients presenting to an E D for evaluation of chest pain, those who made contact with a health care provider were less likely to arrive via ambulance. Key words: emergency medical services; EMS; ambulance; managed care organization; gatekeeper. ACADEMIC EMERGENCY MEDICINE 1998; 5: 587-592ORE THAN 50% of all deaths due to ische-M mic myocardial disease occur before the patient reaches the h~s p i t a l . l -~ Most of these deaths are due to ventricular fibrillati~n.~ The risk of ventricular fibrillation is highest immediately after the myocardial infarction (MI) and decreases with time.6-g Between 15% and 17% of patients with acute MI (AMI) s d e r a cardiac arrest before or during transportation by a n ambulance.6J0 In one study, 20% of patients with MI who were seen within the first hour had a n episode of ventricular fibrillation." Hence, early access to defibrillation is effective in reducing the mortality of patients with AMI.5In our community, patients are instructed to call their physician or their insurance gatekeeper prior to a n evaluation at the ED. Our hypothesis was that contact with a health care professional would increase the use of ambulance transportation by the adult patient coming to the ED for chest pain. METHODSStudy Design. A prospective survey was performed of a convenience sample of adult ED patients presenting with chest pain to determine their mode of arrival and association with physician or insurance gatekeeper. The need for patient consent was waived by the University of Rochester institutional review board (IRB), which also ...