ADVICE SAVE LIVES
February 26, 2013
According to a research article available through the American Heart Association (AHA): Getting an aspirin early in the treatment of a heart attack, along with other treatments EMTs and emergency department physicians provide, can significantly improve your chances of survival.1
Why? Aspirin “greases” the blood platelets and helps prevent blood clots from forming or occluding the arteries when taken routinely in low-dose form.
Yet, despite all the medical evidence leading to that conclusion, aspirin is often the missing link of at-home prehospital emergency care for suspected cardiac arrest, particularly among older patients. Not everyone keeps a container within the expiratory date handy in his/her home’s medicine cabinet.
Perhaps the reason aspirin is not readily on hand relates to the analgesic’s correlation to long-term use to prevent a first heart attack, or a dose prescribed by the family doctor to prevent a second heart attack. People of any age without a history of heart attack might not understand the benefits of aspirin therapy in case of a heart attack.
Based on aspirin’s survival significance in prehospital treatment for heart attack, the International Academies of Emergency Dispatch (IAED) established the Aspirin Diagnostic and Instruction Tool (ADxT) within the Medical Priority Dispatch System (MPDS). Since 2008, (MPDS Version 12.0) Pre-Arrival Instructions have directed callers, where appropriate, to administer aspirin for potential acute coronary syndrome (ACS)/acute myocardial infarction (AMI) patients at the scene of their emergency, prior to the arrival of the ambulance.
The European Resuscitation Council Guidelines have also advocated the use of aspirin, as soon as possible, in all patients with ACS.
As you might know, the IAED never stops evaluating a new tool or protocol. While scientific research and beta testing precede release, research also continues throughout the life of the product or instruction. The IAED incorporates new findings into protocol modification. Users can initiate the process themselves through the Proposal For Change (PFC) process.
A recently published multi-center (international) study—Aspirin Administration by Emergency Medical Dispatchers Using a Protocol-Driven Aspirin Diagnostic and Instruction Tool2—looked at whether EMDs™ can successfully complete the ADxT process and, if appropriate, provide instructions to administer aspirin in the earliest possible stage of the emergency, prior to the arrival of trained responders.
The study analyzed six months of EMD data collected between September 2008 and June 2010 and included all calls recorded under MPDS Chief Complaint Protocol 10: Chest Pain (Non-Traumatic), and Protocol 19: Heart Problems/Automated Internal Cardiac Defibrillator. Results were based on the number of times the ADxT was used, the number of times it was successfully completed, the number of times aspirin administration was advised, as well as the percentage of patients who took aspirin when advised.
Results and conclusions
The authors concluded that a standardized protocol, used correctly by EMDs, supports early aspirin therapy to treat potential ACS/AMI prior to responders’ arrival. The inability to complete the instruction was overwhelmingly due to the arrival of response (48%), followed by the call being lost or the caller hung up (19%).
At the same time, the authors found disparities in actual follow through. In a substantial number of cases (40%), the EMD never opened or used the ADxT, even though the patients met the necessary inclusion criteria.
Other reasons for the tool not being completed related to the caller.
Overall, age played a significant part in the results. The patient’s mean age was higher when the ADxT was completed, although the patients who took aspirin once advised were significantly younger than those who did not. Neither gender nor caller-party type radically influenced aspirin-taking frequency once advised.
As indicated at the beginning of this article, the unavailability of aspirin at the scene was the major non-medical (situational) reason why patients did not take aspirin as directed by EMDs. Of all patients qualifying for potential aspirin treatment, 44.3% had no aspirin to take at the time of a medical emergency.
As often is the intent of research, the study raised additional questions for further investigation. For example, the authors recommend studies to investigate EMD compliance to the use of the ADxT, upon medical director approval, and ways in which to improve the frequency of use. Secondly, a public awareness campaign might be beneficial in encouraging people to keep aspirin on hand—the intervention and outreach of either medical directors and/or departments of health is highly required here. An immediate result to answer the first question is a feature enhancing the new version of the ADxT. Cursor focus is placed on the brightly colored ADxT launch icon button and a modified pop-up box is being added to capture data on the reasons why patients fail to take aspirin despite being qualified and advised to do so.
1 American Heart Association, Aspirin and Heart Disease, http://www.heart.org/HEARTORG/Conditions/HeartAttack/PreventionTreatment..., retrieved Oct. 11, 2012.
2 Barron T, Clawson J, Scott G, Patterson B, Shiner R, Robinson D, Wrigley F, Gummett J, Olola CH. Aspirin administration by emergency medical dispatchers using a protocol-driven aspirin diagnostic and instruction tool. Emerg Med J. 2012 Jul 25. doi:10.1136/emermed-2012-201339.