title: Demographic, belief, and situational factors influencing the decision to utilize emergency medical services among chest pain patients. Rapid Early Action for Coronary Treatment (REACT) study.
abstract: BACKGROUND
  Empirical evidence suggests that people value emergency medical services (EMS) but that they may not use the service when experiencing chest pain. This study evaluates this phenomenon and the factors associated with the failure to use EMS during a potential cardiac event.
  
  
  RESULTS
  Baseline data were gathered from a randomized, controlled community trial (REACT) that was conducted in 20 US communities. A random-digit-dial survey documented bystander intentions to use EMS for cardiac symptoms in each community. An emergency department surveillance system documented the mode of transport among chest pain patients in each community and collected ancillary data, including situational factors surrounding the chest pain event. Logistic regression identified factors associated with failure to use EMS. A total of 962 community members responded to the phone survey, and data were collected on 875 chest pain emergency department arrivals. The mean proportion of community members intending to use EMS during a witnessed cardiac event was 89%; the mean proportion of patients observed using the service was 23%, with significant geographic differences (range, 10% to 48% use). After controlling for covariates, non-EMS users were more likely to try antacids/aspirin and call a doctor and were less likely to subscribe to (or participate in) an EMS prepayment plan.
  
  
  CONCLUSIONS
  The results of this study indicate that indecision, self-treatment, physician contact, and financial concerns may undermine a chest pain patient's intention to use EMS.
authors.affiliation: Department of Emergency Medicine, Oregon Health Sciences University, Portland, USA.
authors.forename: A L
authors.initials: AL
authors.lastname: Brown
authors.forename: N C
authors.initials: NC
authors.lastname: Mann
authors.forename: M
authors.initials: M
authors.lastname: Daya
authors.forename: R
authors.initials: R
authors.lastname: Goldberg
authors.forename: H
authors.initials: H
authors.lastname: Meischke
authors.forename: J
authors.initials: J
authors.lastname: Taylor
authors.forename: K
authors.initials: K
authors.lastname: Smith
authors.forename: S
authors.initials: S
authors.lastname: Osganian
authors.forename: L
authors.initials: L
authors.lastname: Cooper
mesh_terms: D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D003153:Community Health Services / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D017281:Cost of Illness; D003625:Data Collection; D003657:Decision Making; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012648:Self Care; D014861:Washington / Q000453:epidemiology