title: Safe out-of-hospital treatment of chest pain without direct medical control.
abstract: BACKGROUND
  The use of direct medical control (DMC) in the out-of-hospital setting often is beneficial, but has the disadvantage of consuming emergency medical services (EMS) resources.
  
  
  OBJECTIVE
  Uncomplicated, nontrauma, adult patients with chest pain can be treated safely and transported by paramedics without DMC.
  
  
  METHODS
  Retrospective chart review of all nontrauma, adult patients with chest pain treated in a combined rural and suburban EMS system during a 2-year period (December 1990 through November 1992) was conducted. Before November 1991, DMC was mandatory for all patients with chest pain. Beginning 01 November 1991, if a patient had resolution of a pain either spontaneously, with administration of oxygen, or after a single dose of nitroglycerin, DMC was at the discretion of the paramedic. Using the above criteria for inclusion, three study groups were defined: Group 1, before protocol change; Group 2, after protocol change without DMC; and Group 3, after protocol change when physician contact was obtained, but not required. These groups were compared for the following parameters: 1) scene time; 2) time to administration of first dose of nitroglycerin; 3) time interval between measurement of vital signs; 4) oxygen use; 5) intravenous access; and 6) electrocardiographic monitoring. Continuous and categorical variables were analyzed by multivariate and univariate analysis of variance and chi-square tests, respectively.
  
  
  RESULTS
  Of 308 nontrauma, adult patients with chest pain, 71 met inclusion criteria in Group 1, 40 in Group 2, and 34 in Group 3. No statistically significant differences were identified in any of the study parameters.
  
  
  CONCLUSIONS
  Adult patients with chest pain who have no other symptoms or complicating conditions can be treated appropriately be paramedics without DMC.
authors.affiliation: Department of Emergency Medicine, Albany Medical Center, Albany, New York, USA.
authors.forename: M
authors.initials: M
authors.lastname: McErlean
authors.forename: N
authors.initials: N
authors.lastname: Raccio-Robak
authors.forename: J M
authors.initials: JM
authors.lastname: Bartfield
authors.forename: D
authors.initials: D
authors.lastname: Hermes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000488:Allied Health Personnel; D002637:Chest Pain / Q000175:diagnosis / Q000628:therapy*; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York; D010820:Physicians; D012189:Retrospective Studies