title: Patients with chest pain calling 9-1-1 or self-transporting to reach definitive care: which mode is quicker?
abstract: OBJECTIVE
  We examined differences in transport times for patients with chest pain who used private transportation compared with patients who used emergency medical services (EMS) to reach definitive medical care.
  
  
  METHODS
  This was a retrospective cohort study with data used from the Rapid Early Action for Coronary Treatment (REACT) trial conducted in 20 US cities. Elapsed time to care was examined through the use of (1) decision to seek care to initial care (emergency department [ED] arrival versus EMS arrival on scene [n=1209]); (2) decision to ED arrival (for both groups [n=2388]); (3) time to thrombolytic therapy once admitted to the ED (for both groups [n=309]); and (4) decision to seek care to thrombolytic therapy (n=276). Elapsed travel times were ranked within Zip Codes and submitted to a nested analysis of variance model to determine if elapsed times were different between modes of transport.
  
  
  RESULTS
  Private transportation (35 minutes) resulted in faster ED arrival than using EMS (39 minutes, P =.0014). However, if one considers EMS treatment to be initial care, calling 9-1-1 (6 minutes) resulted in much quicker care than patients using private transportation to the ED (32 minutes, P <.001). Transport by EMS resulted in a shorter elapsed time to thrombolytic administration compared with patients using private transportation when considering ED "door-to-needle" time (32 vs 49 minutes, respectively [P <.001]) or time from decision to seek care until administration of thrombolytic therapy (75 vs 92 minutes, respectively, [P =.042]).
  
  
  CONCLUSIONS
  Although private transportation results in a faster trip to the ED, quicker care is obtained with the use of EMS.
authors.affiliation: Intermountain Injury Control Research Center, University of Utah School of Medicine, Salt Lake City, Utah 84108-1284, USA.
authors.forename: Caroline B
authors.initials: CB
authors.lastname: Hutchings
authors.forename: N Clay
authors.initials: NC
authors.lastname: Mann
authors.forename: Mohamud
authors.initials: M
authors.lastname: Daya
authors.forename: Jon
authors.initials: J
authors.lastname: Jui
authors.forename: Robert
authors.initials: R
authors.lastname: Goldberg
authors.forename: Lawton
authors.initials: L
authors.lastname: Cooper
authors.forename: David C
authors.initials: DC
authors.lastname: Goff
authors.forename: Carol
authors.initials: C
authors.lastname: Cornell
mesh_terms: D000328:Adult; D000465:Algorithms; D000704:Analysis of Variance; D002637:Chest Pain / Q000188:drug therapy*; D015331:Cohort Studies; D003657:Decision Making; D003710:Demography; D004631:Emergency Medical Service Communication Systems; D004632:Emergency Medical Services / Q000592:standards / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D015912:Thrombolytic Therapy; D013996:Time and Motion Studies; D014186:Transportation / Q000592:standards / Q000706:statistics & numerical data*; D014187:Transportation of Patients / Q000379:methods* / Q000592:standards