Errors of Omission in the Treatment of Prehospital Chest Pain Patients

University of Pittsburgh Affiliated Residency in Emergency Medicine and the Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Prehospital Emergency Care (Impact Factor: 1.76). 01/2005; 9(1):2-7. DOI: 10.1080/10903120590891688
Source: PubMed


Despite the widespread use of standard treatment protocols, there are few published data regarding paramedic protocol adherence. In this descriptive study, the authors sought to assess the frequency and nature of deviations from a standardized treatment protocol for the chief complaint of chest pain. They also sought to quantify any time delays in treatment of potential ischemic cardiac chest pain.
A retrospective review of written documentation obtained from four ambulance services in a mid-Atlantic state was completed. A convenience sample of consecutive emergency medical services (EMS) records was obtained from January 2001 to May 2002, and 75 calls were selected from each service (N = 300).
Neither the median scene times nor the response times varied among the four services in the study. However, the suburban ambulance service (service 1) did have a significantly longer transport time (19 minutes) than the rural (14 minutes) and the urban (11 and 10 minutes) services (p < 0.05). Documentation of history and physical characteristics varied widely for each service. The patient took aspirin 10% of the time prior to EMS arrival, yet paramedics gave it additionally 50% of the time, while nitroglycerin was given in 73% of cases of suspected cardiac ischemia. Posttreatment vital signs for nitroglycerin were documented 30% of the time for three of the four services, while the other service documented these 75% of the time. Medical command contact varied by agency (80-100%), as did the receipt and completion of medical orders.
Paramedics may delay transport of patients with potential cardiac ischemia. Deviations from protocol occur frequently and the care documented for prehospital patients with chest pain is variable. The expected care described by written protocols does not correlate with the treatment documented.

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Available from: Jon C Rittenberger
    • "The prehospital work is accomplished by protocols and clinical guidelines. Evidence-based guidelines increase the quality of care in the prehospital setting [7] [8], but compliance with guidelines is sometimes poor, for example, regarding patients with chest pain [9] [10] [11], pediatric patients with asthmatic symptoms [12], patients with exacerbated chronic obstructive pulmonary disease [13], and patients with burns [14]. The reason for the poor compliance in prehospital care is not known. "
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    • "Their risk of injury and death is greater than the general public's (Maguire et al. 2005; Maguire et al. 2002; Reichard, and Jackson 2010). Furthermore, medical errors, accidents, and adverse events occur frequently in EMS (Rittenberger, Beck, and Paris 2005; Wang et al. 2008a; Wang et al. 2008b; Wang et al. 2006; Wang et al. 2009). Positive teamwork is associated with reduced errors and improved patient safety in multiple healthcare settings (Kohn, Corrigan, and Donaldson 2000; Lemieux-Charles, and McGuire 2006). "
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