- The Washington Times - Tuesday, July 11, 2000

More than half the 1.1 million Americans who experience a heart attack each year die before reaching the hospital, and it appears many do so simply because they failed to call 911.

A study appearing today in Circulation, an American Heart Association publication, reports the public tends to understand the need for summoning an emergency medical service (EMS) for heart attack victims. Yet on average, emergency teams transport just 23 percent of patients arriving at emergency rooms with chest pain.

Injury epidemiologist Clay Mann, a professor at the University of Utah School of Medicine, explains: "heart attack victims apparently believe that if you call 911 you won't get treatment until you reach the emergency department. That's a misperception. At any rate, victims tend to drive themselves to the hospital, or are driven there."

In fact, 60 percent of the 875 heart attack victims in the survey were driven to the emergency room. Sixteen percent drove themselves.

Mr. Mann authored the study, sponsored jointly by the National Heart, Lung and Blood Institute and the American Heart Association. "We were concerned that so few heart attack victims were contacting 911," he says. "We conducted the study in 20 representative communities and found the rates of patients actually calling EMS ranged from 10 to 50 percent."

In trying to explain why this is so, Mr. Mann's team ruled out the notion that people simply may be unaware of EMS. The researchers asked a cross-section of 962 Americans what they would do if they saw someone having a heart attack.

Eighty-nine percent said they would call EMS. The rest would drive the victim to the hospital.

The researchers found that heart attack victims chose not to call EMS because they had taken aspirin and felt protected or thought they had heartburn and took an antacid. But cost is a factor, too.

Victims in areas where EMS is a tax-paid public service used the service twice as often as others.

Commenting on Mr. Mann's findings, Dr. Robert Cates, vice chairman of Inova Fairfax Hospital's (Va.) emergency department, says: "Obviously, heart attack victims believe they'll get to the hospital quicker if they drive. That's probably not true, but it's beside the point. The issue is how to get the quickest treatment, and that comes from EMS."

EMS crews begin treating heart attack victims on arrival. They do basic diagnostic testing and administer aspirin. They radio the hospital and report the patient's condition. This enables emergency room staff to prepare for the patient, who is hurried into a treatment bay where clot-busting drugs and other therapies are immediately administered. These measures are known to reduce the chance of death by 25 percent.

Dr. Cates points out that patients who drive themselves to medical help endanger others as well as themselves. He asks:

"What happens if the attack victim collapses behind the wheel and there's a crash? What happens if someone else drives, and the victim lying in the back seat collapses? The driver can't help.

"Heart attack victims think, 'I can make it.' But in the midst of dying, some things are out of their control."

The heart association president, Dr. Rose Marie Robertson, concludes, "The study suggests the public needs to hear more about calling 911."

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