ďIím just soreÖ I must have pulled a muscle in my chest or something.Ē
ďI keep taking these antacids, but theyíre defective or something. They arenít working like they should.Ē
ďI have drank like 5 sodasÖ if I could only belch I would feel so much better!Ē
If youíve been in the EMS business long enough Iíll bet you have heard those exact words before from different people in disparate situations. Theyíre describing the uncomfortable feeling their having, and not the one theyíre sure theyíre not actually feeling in their chests. Theyíre describing to you the uncomfortable feeling theyíre having within their psyche. Theyíre describing fear. Theyíre describing doubt. Theyíre describing the hope they want to have that theyíre not actually feeling pain in their chests. They donít want to be having something wrong with their hearts. They donít want to be having a HEART ATTACK. This couldnít be happening to themÖ this canít be. Theyíre sorry they bothered you with a silly 911 call. They didnít want to have all this fuss made for them by the ambulance and the fire truck and the police officers and the ER staff and the Doctors. This is all just so silly! Canít we all just understand that if they could only belch that theyíd feel better?
But, unfortunately thatís just not the case. That wonít be their path. That wonít be happening for them today. Today, theyíre having a myocardial infarction and theyíve got a blocked artery in their heart that is causing it to tell them somethingÖ they just donít want to listen. Honestly, the artery in their heart has been narrowing for a while now, theyíve just been ignoring the warning signs and not taking care of the problem for so long that their heart is becoming annoyed with them. Today, it is getting downright angry at them. Soon, their heart might just become ďPissed OffĒ and go on strike if they ignore what itís telling them. Today itís screaming at them and theyíre still trying to do just thatÖ They want to ignore the feeling theyíre having, but now theyíre scared and theyíre starting to bargain. They donít want to be someone whoís having a heart attack. This canít happen to them. They donít have heart attacks. That is something theyíre worried about happening to other people, you knowÖ people who arenít them.
And yet the pain is there. Itís constant. They canít seem to shake it or rationalize it away. Belching wonít help, and neither will taking antacids, drinking water, stretching, breathing deeply, or calling their friends to ask them about it. The pain, the weird feeling, the sickness, the dreadÖ itís not stopping and now it has been going on for hours.
Fear creeps into these patients quickly but still they deny that anything is really wrong. When finally they present for treatment, whether by driving themselves to an urgent care center, by calling their doctor, or by even going to the local emergency room, theyíre always shocked and in denial when theyíre told ďThis could be a heart attackĒ. They defensively react and think that the medical care that is being ďforced uponĒ them is ďstupidĒ or unnecessary, or is ďJust too much fussĒ. They will still try to not believe itÖ well, part of them will try. They usually maintain a front. They donít want to know that they could be indeed having a HEART ATTACK and that now is the time they need to trust the medical profession more so than they ever have trusted it in their life. They canít fix this on their own, they canít wish the pain away, and they canít self heal the problem. By this timeÖ no rationalization or self-healing thing will work. They need hard, conventional medical careÖ and they need it now.
As a paramedic, I have seen the type of patient Iíve described above many, many times. I have diagnosed acute myocardial infarctions in multitudes of patients who were angry at me for bestowing even the possibility of the diagnosis of ďHeart AttackĒ upon them. Some have sworn at me, some have been relieved when I believed them, and all were scared. As a paramedic, I can diagnose and begin treatment on many types of cardiac conditions that fall into the ďHeart AttackĒ category people fear so much. Paramedic and Ambulance care in the first stages of a heart attack can make a huge difference in how bad it gets and how much damage is prevented. Ambulance care during a heart attack saves not only lives, but it saves muscle. Consider the fact that during a heart attack, 1% of heart muscle is lost EVERY MINUTE it is left untreated. EMS can intervene, make a working diagnosis, and provide treatment and medications that will help slow or stop the damage.
And people really just need to forget about doing anything else other than calling 911 when they may be having one.
Really, if youíre even the least bit concerned that you could be having a heart attack, you should drop everything and just call 911. Donít call your mom, your son, your friend, your spouse, or even your doctor. Call 911. Donít do anything elseÖ call 911 and just sit there. Someone in an ambulance will show up that knows what theyíre doing. Theyíll help you and you need their help. Now is the time to trust them and to let them do their job. Donít ignore the pain, donít worry about bothering them, and donít feel bad for asking for help. You need an ambulance. Theyíre the best thing for you.
As a paramedic or EMT who is presented with a patient like this, you have a hard job. Not only must you provide appropriate diagnosis and treatment, but you also have to convince the patient to believe you and allow appropriate care. Reading a 12-lead EKG is easy compared to telling the patient and their family that you must bypass the closest hospital that they want to go to in favor of taking them to a bigger hospital, farther away, that has the cardiac surgery capabilities and cardiology services that they really need. This is the time to become a politician. This is the time to earn trust. This is the time that your skills as a caring and compassionate healthcare provider are going to be put to the test.
And if everyone stopped ignoring the problem and trusted their feelings, a lot of lives would be saved.
In the community that I serve, it is actually better medicine for a person having a heart attack to call 911 than it is for them to present to the emergency room. Even if that person immediately presents to the ER at the first warning sign of a heart attack, the ambulance still would have provided better care for them. Todayís ambulances bring appropriate care and highly trained medical professionals right to the patientís side. Paramedics and EMTs can recognize the signs, help rule out mimics of a heart attack, perform diagnostic tests and an EKG, and can begin treatment with medications that stop, slow down, or even reverse the damage to the heart tissue in progress. The paramedics or EMTs in the ambulance can communicate with cardiologists and ER physicians at the local facilities and have a system in place to bring patients having a heart attack right into the facilities best prepared to take care of them, bypassing facilities that cannot provide the surgical intervention they may needÖ right away. Being immediately and appropriately treated by a paramedic and the emergency cardiology team early enough in a heart attack can make it almost seem like no big deal.
And thatís what we all want our heart attacks to be if and when we have one: No big deal.
So Iím telling you all out there. Donít guess, donít rationalize, and donít hope it will go away. At the very first realization that the feeling youíre having, the pain, the ache, the soreness, the unusual heartburn, or however you describe it may be a heart attack; Call 911. Then sit and wait for us. We promise we wonít be mad if itís something less serious.
But youíll feel better, much better, no matter what it is.
Please, just call 911.