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Abstract

Introduction: Few studies have described the clinical course and outcome of specific cohorts of patients identified by their 911 call type.  Chest pain patients are especially important to study due to the time-sensitive nature of cardiac-related treatment.

Objective: To describe the clinical course and outcome of patients identified as an MPDS Card 10 (Chest Pain), including the positive predictive value (PPV), with primary Emergency Department (ED) diagnosis.

Methods: All 911 calls between November 1, 2011 and July 31, 2013, handled on Card 10 and pertaining to a patient >=16 years of age, were linked with their health outcomes. The deterministic linkage strategy matched based on personal health number, gender, and transport destination with a 2-hour time frame etween EMS arrival and triage. Key method was descriptive analysis of the patient’s clinical course, and PPV of the MPDS Card 10, using primary ED diagnosis as the gold standard are provided. Setting was an Accredited Center of Excellence by the International Academies of Emergency Dispatch, serving a population of 105,000, with an annual call volume of 12,000, and dispatching 16 units over a 46,000 sq./km area.

Results: A total of 20,683 calls were handled during the study period at the site.  Of those, 616 (3.0%) were handled on the Chest Pain Protocol.  570 of these were successfully linked to the ED record (92.5%).  Of these calls, the median age was 71 years; 274 were female.  Of the successfully-lined cases, 318 (55.8%) received a primary ED diagnosis related to a cardiac condition; 252 received a primary ED diagnosis not related to a cardiac condition, with the top three non-cardiac diagnoses being anxiety disorder, COPD, and abdominal pain.

Conclusion: Almost half of Chest Pain Protocol patients do not have a primary ED diagnosis related to a cardiac condition. One-third of patients are admitted to the hospital. Overall mortality (9 out of 570 patients) is less than 2%. These results represent an important starting point to improve the detection of cardiac patients at the time of the 911 call.