Brett Patterson

Brett Patterson

Best Practices

By Brett Patterson


The caller reports tightness in his or her chest, but denies it is heart related. The caller also reports difficulty breathing and a history of COPD and, in addition, tells the calltaker that he (or she) hasn’t used the breathing machine that day. Would this be considered chest pain due to the tightness in the chest, or a breathing problem? Or could the calltaker have chosen either protocol?


Lt. Audrey V. Boyd, RPL

Communications Coordinator

Greenville County EMS

Greenville, S.C., USA


Chest “tightness” is a common expression used to describe wheezing, especially in asthmatic or COPD patients. However, it is also listed in the Heart Attack Symptoms list. The patient you describe is most likely correct to place his or her problem in the lungs; however, it cannot be left to the EMD to diagnose the etiology of the sign/symptom. Fortunately, the protocol addresses this.

“When the complaint description involves both NON-TRAUMATIC chest pain/heart attack symptoms and breathing problems, choose the Chief Complaint Protocol that best fits the patient’s foremost symptom, with ECHO-level conditions taking precedence. (>= 16, alert, no reported STROKE symptoms) Use the Aspirin Diagnostic & Instruction Tool on either protocol as appropriate.”

So, the simple answer to your question is use Protocol 6: Breathing Problems (patient’s foremost complaint), tell the patient to use his or her inhaler or nebulizer, and then use the Aspirin Diagnostic & Instruction Tool.

Brett Patterson

Academics & Standards Associate

Medical Council of Standards Chair