Doctors to test if quieter 911 response would encourage chest-pain patients to seek help

Friday, April 12th 2002, 12:00 am
By: News On 6

WASHINGTON (AP) _ The typical American with chest pain waits two hours before coming to the emergency room, despite pleas by heart experts to call 911 right away.

Paramedics in Richmond, Va., will soon pilot-test a system doctors hope will entice people to call for help sooner _ by easing the embarrassment and loss of control that ensue when ambulances, policemen, even fire trucks swarm to a 911 call.

Instead, paramedics would quietly arrive, link the patient to the hospital via telemedicine, and do sophisticated tests to see if the patient really is having a heart attack. If not, they install a wearable heart-restarter on the patient just in case, and a visit to the doctor can be delayed until the next day.

If there was a heart attack, the patient arrives at the emergency room already diagnosed.

``Is this a wild idea?'' Dr. Joseph Ornato of Virginia Commonwealth University asked a meeting of heart experts Friday. ``No. ... It's bringing back the old-fashioned house call.''

Ornato hopes to begin the pilot-testing within a year.

The concept depends on technology recently approved by the Food and Drug Administration: a wearable defibrillator, and a full-torso EKG system that provides more readings than those the most advanced ambulances now carry. That ``body map'' EKG uses colors like a weather radar map to literally light up the spot where a heart attack may be occurring, easy for paramedics to learn to use, Ornato said.

Add a briefcase-sized computer to link to the hospital in real-time _ one NASA developed and tested on Mount Everest _ and the patient may get a faster diagnosis than he or she would in a crowded emergency room, he said.

``All of us are going to look at it with great anticipation,'' said Dr. James Atkins of the University of Texas Southwestern Medical Center.

A paramedic house call is an ``appealing concept,'' added Dr. Rose Marie Robertson, past president of the American Heart Association, which will help fund Ornato's experiment.

About 1.1 million Americans will have a heart attack this year. Emergency rooms will get over 6 million visits from people with chest pain. The trick is separating the one out of three who's really having a heart attack or angina that is a symptom of heart disease from the others who are OK.

Such diagnosis isn't perfect _ up to 5 percent of people sent home from the emergency room are missed heart-attack cases, while thousands of healthy people undergo hours or days of unnecessary hospitalization.

But if you are having a heart attack, time counts, Atkins stressed. One major study found getting to the hospital within 70 minutes of experiencing chest pain can cut chances of dying by 80 percent.

Yet, patients typically wait two hours _ in denial _ guzzling antacids or popping aspirin and seeking reassurance from relatives that they shouldn't overreact, he lamented.

And 89 percent of people surveyed in 10 cities said they would call an ambulance if they witnessed someone having a heart attack _ but in a four-year study, only 23 percent of those people who later had chest pain actually did so.