title: Factors influencing choice of pre-hospital transportation of patients with potential acute coronary syndrome: An observational study.
abstract: OBJECTIVE
  To determine factors associated with ambulance use in patients with confirmed and potential acute coronary syndrome presenting to the ED.
  
  
  METHODS
  A convenience sample of patients (n = 247) presenting to the ED from April 2014 to January 2015 with suspected acute coronary syndrome were included in the study. Data on mode of transport and patient demographics were collected from the Emergency Department Information System database. Clinical data were collected from chart records and information systems. A questionnaire assessed reasons for using a chosen method of transport, symptom timing and characteristics, acute coronary syndrome knowledge, and awareness of the National Heart Foundation Early Warning Symptoms campaign.
  
  
  RESULTS
  Approximately half the patients (49.4%) assessed with symptoms of potential acute coronary syndrome used ambulance transport to the ED. Patients who arrived by ambulance were older than those not arriving by ambulance (mean 56.7 years vs 51.7 years, P = 0.01). Risk factors were not associated with ambulance use. Dizziness (P < 0.01), sweating (P = 0.03), nausea (P = 0.03) and vomiting (P = 0.04) were associated with increased ambulance use. Mean systolic blood pressure was lower in the ambulance group (136 mmHg, standard deviation [SD] = 19.8) than in the non-ambulance group (143 mmHg, SD = 25.9). Awareness of the National Heart Foundation Heart Attack Warning Signs campaign was not associated with ambulance use.
  
  
  CONCLUSIONS
  Patients with possible ischaemic symptoms who are at a high risk of cardiac disease do not utilise ambulance services more than low risk patients. In general, transport to hospital using ambulance services by patients with symptoms of possible acute coronary syndrome is low despite community campaigns.
authors.affiliation: Toowoomba Rural Clinical School, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Tim
authors.initials: T
authors.lastname: Lavery
authors.affiliation: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.|School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.|School of Public Health, Queensland University of Technology, Brisbane, Queensland, Australia.
authors.forename: Jaimi H
authors.initials: JH
authors.lastname: Greenslade
authors.affiliation: School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.|School of Public Health, Queensland University of Technology, Brisbane, Queensland, Australia.|Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: William A
authors.initials: WA
authors.lastname: Parsonage
authors.affiliation: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: Tracey
authors.initials: T
authors.lastname: Hawkins
authors.affiliation: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: Emily
authors.initials: E
authors.lastname: Dalton
authors.affiliation: School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.|Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Hammett
authors.affiliation: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.|School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.|School of Public Health, Queensland University of Technology, Brisbane, Queensland, Australia.
authors.forename: Louise
authors.initials: L
authors.lastname: Cullen
mesh_terms: D054058:Acute Coronary Syndrome / Q000523:psychology* / Q000628:therapy; D000328:Adult; D000368:Aged; D000552:Ambulances / Q000706:statistics & numerical data; D002755:Choice Behavior; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007297:Inpatients / Q000523:psychology* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D014187:Transportation of Patients / Q000379:methods* / Q000706:statistics & numerical data
keywords: chest pain; emergency department; health education; myocardial ischaemia; transportation of patient