The 'Heart Attack Survival Kit' project: an intervention designed to increase seniors' intentions to respond appropriately to symptoms of acute myocardial infarction.

The purpose of this study was to test the effectiveness of a 'Heart Attack Survival Kit', disseminated via two different delivery methods, designed to increase seniors' intentions to call 911 and take an aspirin in response to a cardiac emergency. Twelve-hundred seniors were randomly assigned to (1) receiving a Kit via a home visit by an Emergency Medical Technician (EMT), (2) receiving a Kit via direct mail or (3) a control group. All participants were telephoned and asked how they would respond to a cardiac emergency. Results showed that respondents in the intervention group (EMT and direct mail group combined) reported a greater frequency of the recommended coping response to AMI (39%) than respondents in the control group (10%) (P < 0.000). Within intervention groups, 47% in the EMT group and 30% in the direct mail group (P < 0.000) reported intentions to take the appropriate response to AMI. The results suggest that a Heart Attack Survival Kit, especially when delivered door-to-door by EMTs, can be an effective way of educating seniors about cardiac emergencies.

The emergency department experience of chest pain patients and their intention to delay care seeking for acute myocardial infarction.

This study investigated how patients' emergency department experience was related to their intention to delay action in response to future symptoms of acute myocardial infarction. A sample of 426 persons admitted to the emergency department with a chief complaint of chest pain and released from the emergency department were contacted by telephone. Patients were queried about their affective response to the emergency department experience, their satisfaction with emergency department staff communication, their intention to delay prompt action for acute myocardial infarction symptoms in the future, the influence of others in the decision to seek care, and medical and demographic status. The results of a mixed model linear regression analysis showed that the less education patients had (p = 0.007), the less sure they felt that going to the emergency department had been "the right thing to do" (p = 0.004), and the greater the degree of embarrassment (p = 0.0001), the greater was the intention to delay action for future symptoms of acute myocardial infarction. The results also showed that those patients who were prompted by health professionals to go to the emergency department were less likely to report intentions to delay for future symptoms (p = 0.036). It is important that emergency department staff reassure chest pain patients who are sent home that they did the right thing by coming to the emergency department for their symptoms. Providers need to be particularly sensitive to feelings of embarrassment.

'Call fast, Call 911': a direct mail campaign to reduce patient delay in acute myocardial infarction.

OBJECTIVES: A 10-month direct mail campaign was implemented to increase use of emergency medical services via 911 calls and to reduce prehospital delay for individuals experiencing acute myocardial infarction symptoms. METHODS: This prospective, randomized, controlled trial involved three intervention groups (receiving brochures with informational, emotional, or social messages) and a control group. RESULTS: Intervention effects were not observed except for individuals who had a history of acute myocardial infarction and who were discharged with a diagnosis of acute myocardial infarction; their 911 use was meaningfully higher in each intervention group than in the control group. CONCLUSIONS: The mailings affected only the individuals at greatest risk.

Utilization of emergency medical services for symptoms of acute myocardial infarction.

OBJECTIVE: To examine patient characteristics and situational and clinical factors that affect utilization of Emergency Medical Services (EMS) for symptoms of acute myocardial infarction (AMI). DESIGN: Telephone interview of patients hospitalized with suspected AMI. SETTING: Nine hospitals in King County, Washington. PATIENTS: Patients admitted to a coronary or intensive care unit between October 1, 1986, and December 31, 1987, with suspected AMI occurring out of hospital. Spouses of patients who met criteria but died during the hospitalization also participated. OUTCOME MEASURES: Patient demographics, coping strategies, situational factors, prior cardiac history, perceived symptom severity, belief about the nature of condition, and method of transportation. RESULTS: Descriptive statistics showed that although few patients called EMS as a "first thing" in response to symptoms, almost half of all patients called EMS before being hospitalized. Stepwise logistic regression analyses revealed that being older, the belief that one was experiencing a heart attack, the presence of other people (including the spouse), and the lack of physical activity at time of symptom onset, were related to both greater and quicker utilization of EMS. Additionally, education, medical history of angina, and severity of symptoms also were related to utilization of EMS. CONCLUSION: The findings are discussed in a theoretical context, using Leventhal's self-regulatory model to suggest avenues for future research and interventions.

Increasing the efficiency of emergency medical services by using criteria based dispatch.

STUDY OBJECTIVES: To determine whether criteria based dispatch (CBD) improved the efficiency of the emergency medical services system. DESIGN: A before and after design was used to measure effects of CBD. Data were reviewed from medical reports from January 1986 through June 1992. SETTING: King County, Washington, excluding the city of Seattle. PARTICIPANTS: Residents who called 911 to report a medical emergency. INTERVENTIONS: Emergency medical dispatching (EMD), basic life support (BLS), and advanced life support (ALS). RESULTS: Findings show a decrease in ALS responses for two tracer conditions that medical control physicians determined not require ALS intervention. The percentage of febrile seizures in which paramedics responded decreased from 41% to 21% (P < .001). The percentage of cerebrovascular accidents in which paramedics responded decreased from 41% to 28% (P < .001). CBD led to a decrease, from 4.7% to 3.8% (P < .001), in frequency of requests by BLS units for dispatch of ALS units. There was no increase in the time required to dispatch each call. CONCLUSION: CBD increased the efficiency of the EMS system by significantly reducing ALS responses to incidents not requiring ALS intervention and reducing requests by BLS units for dispatch of ALS units while maintaining a consistent time from receipt of call to dispatch.

Impact of direct mail intervention on knowledge, attitudes, and behavioral intentions regarding use of emergency medical services for symptoms of acute myocardial infarction.

This study evaluated a direct mail intervention called the "Call Fast, Call 911" campaign designed to increase use of emergency medical services for symptoms of acute myocardial infarction. The campaign was targeted at individuals over the age of 50. Persons over 50 years of age (N = 130,000) in King County, Washington, were randomly assigned to intervention or control groups. Individuals in the intervention groups received six direct mail pieces over a 1-year period encouraging them to call 911 quickly in response to chest pain. A postintervention telephone survey of a random sample of households (N = 434) assessed the impact of the campaign on knowledge, attitudes, and behavioral intentions regarding use of emergency medical services for symptoms of acute myocardial infarction. The results showed no significant differences between intervention and control groups in terms of knowledge of AMI. However, there were significant differences in beliefs and behavioral intentions to call 911 in a cardiac emergency.

Accuracy of determining cardiac arrest by emergency medical dispatchers.

STUDY OBJECTIVE: To identify and determine the rates of delivery and performance of telephone CPR in noncardiac arrest incidents. DESIGN: We studied prospectively all out-of-hospital cardiac arrest and potential cardiac arrest incidents from July 1 through October 31, 1992. SETTING: King County, Washington, excluding the city of Seattle. PARTICIPANTS: Persons with cardiac arrest or an initial complaint resembling cardiac arrest who received emergency medical services. INTERVENTIONS: Dispatcher-assisted telephone CPR. MEASUREMENTS AND MAIN RESULTS: Three hundred fifty-eight incidents of cardiac arrest, respiratory arrest, and potential cardiac arrest were reviewed. Telephone CPR was offered appropriately in 61 of 87 cases (70%) and inappropriately in eight of 154 potential cardiac arrests (5.2%) (95% confidence interval, 1.7%, 8.7%). Ventilation instructions were performed appropriately in 52 of 87 cases (60%) and inappropriately in three of 154 potential cardiac arrests (1.9%) (95% confidence interval, 0%, 4.1%). Chest compressions were performed appropriately in 26 of 68 cardiac arrests (38.2%) and inappropriately in two of 173 potential cardiac arrests (1.2%) (95% confidence interval, 0%, 2.8%). CONCLUSION: We found a low rate of performance of telephone CPR in King County for incidents resembling cardiac arrest. This finding suggests that the protocols designed for dispatcher-assisted telephone CPR effectively screen out those incidents that may initially resemble cardiac arrest.