My condolences, very sorry for your loss.

I work as an EMT (911) and resourcing is certainly a problem. In my small city, our response time is around 5 minutes, and if we need to upgrade to get paramedics, that’s maybe another 5-10.

However, if we are out on a call, out of service, or the neighboring city is on a call, now the next closest unit is 15+ minutes away.. sometimes there can just be bad luck in that nearby units are already out on multiple calls that came in around the same time, making the next closest response much further.

for a heart attack or unstable angina, the most an EMT will do (for our protocols) is recognize the likely heart attack, call for paramedics to perform an EKG to confirm the MI, administer 4 baby aspirin to be chewed and/or nitro (rx only), and monitor closely in case it becomes a cardiac arrest. If medics are far away we will probably head immediately to a hospital with a catheterization lab, or rendezvous with medics for them to takeover transport.

The few goals though:

- recognition (it could also be something equally bad/worse like an aortic aneurysm).

- aspirin to break any clots, assist administering nitro if prescribed.

- getting to a cath lab.

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frenchman_in_ny 5 hours ago | parent | next [-]

I'm coming at this as someone who had an MI at a relatively young age:

For the goals -- and this may differ between EMT / paramedic & protocols -- but I would really wish that there was a blood draw done in the field. Before they bring you to the cath lab with a suspected MI, the ER is likely going to draw blood to get troponin levels at a 2-hour interval. You could save some time & heart muscle by getting a blood sample (containing initial levels) in the field.

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DrewADesign 4 hours ago | parent | next [-]

Maybe paramedics, but basic EMTs don’t even start IVs where I am— It’s the sort of thing you can get certified to do in a few weeks and pays about as much as entry-level fast food work. Phlebotomy is a lot more nuanced afaik.

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jaggederest 4 hours ago | parent [-]

There's a lot of interesting research on paramedics vs emts (I believe the term of art is basic life support vs advanced cardiac life support). In areas where there is a good ER, it's better to have low level basic life support and break the sound barrier to the ER than do significant intervention on site but slow arrival at the hospital, as far as I am aware.

	▲	captainkrtek 4 hours ago \| parent \| next [-]
		There is a chain of things that need to be done - early recognition - early administration of aspirin and/or nitro if indicated - activation of, and transport to, a hospital with catheterization capabilities. If medics can show up and do multiple ekgs to confirm and en route, thats even better. But critically the blockage needs to cleared, and they need definitive care (cath lab).
	▲	4 hours ago \| parent \| prev [-]
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4 hours ago | parent | prev | next [-]

[deleted]

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captainkrtek 5 hours ago | parent | prev [-]

Certainly protocol dependent, and likely more in the paramedic realm.

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prmph 5 hours ago | parent | prev | next [-]

Is it recommended to take or give aspirin ASAP before the EMTs arrive? If so, I wonder if the dad took it.

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laszlojamf 4 hours ago | parent | next [-]

Apparently it's no longer recommended, since it could also be an aortic rupture, and aspirin would make it worse. https://www.health.harvard.edu/heart-health/should-i-take-an...

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captainkrtek 4 hours ago | parent | next [-]

Depends on protocols, but hence why EMS’ job is recognition of the right issue (the best we can do), there are things we can evaluate to determine if we think its an aortic aneurysm even at the emt level to rule that out before making the determination to give aspirin (eg: comparing bilateral blood pressures, checking for pulsating masses)

a heart attack is far more common than an aortic aneurysm.

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laszlojamf 4 hours ago | parent [-]

would comparing bilateral blood pressure (which I assume the patient could do themselves) be enough? I'm not asking for medical advice, just like... what would _you_ do if it was you who had sudden chest pain?

	▲	captainkrtek 3 hours ago \| parent [-]
		Id encourage you (generally, outside of hn) to lookup the symptoms of a heart attack and aortic aneurysm. A aortic aneurysm can present with a pulsating mass in the abdomen, and is more common in older people and smokers. The inner lumen of the aorta starts to separate and blood can flow differently or be restricted, eg: right arm bp may be different than left arm. But absence of that doesn’t rule it out entirely. Whereas a heart attack is going to feel pain in the chest, perhaps radiating to the jaw, shoulder, back, maybe nausea, sweating, and an impending sense of doom. Automated bp cuffs are pretty inaccurate imo, we use them at the tail end of transport to the hospital and they usually spit out wild numbers. An auscultated bp with a stethoscope and sphygmomanometer is the gold standard. Bottom line, If you are having chest pain, call 911.

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roncesvalles 4 hours ago | parent | prev [-]

Thank you for sharing.

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pugio 5 hours ago | parent | prev | next [-]

Assuming no sensitivities/allergies, give 300mg chewed for faster absorption immediately. Normally (where I am) the dispatcher will tell you to do that on the phone.

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captainkrtek 5 hours ago | parent | prev [-]

Yes you could (assuming no allergies or gi bleeds) and just inform the incoming EMTs

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tredre3 4 hours ago | parent [-]

How can one preemptively test if they have an allergy? Is there a dosage that is known to trigger detectable allergy symptoms without going full anaphylaxis?

I'm getting up there in age and that is presumably something that I should learn about myself...

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captainkrtek 4 hours ago | parent [-]

As an EMT, I’d say to ask your primary care provider :-)

Don’t want to suggest you do something and end up with anaphylaxis.

	▲	rogerrogerr 2 hours ago \| parent [-]
		And this right here is the problem. Possibly-imperfect knowledge is being self-censored for legal concerns, and what we are left with is silence. A bunch of people don’t even have a primary care provider now.

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ryanjshaw 4 hours ago | parent | prev | next [-]

Possibly a dumb question, but wouldn’t the other thing you do be to carry the guy out on a stretcher? It seems like her dad was able to get into the car but that last bit where he got out at the hospital and walked was just too much. Or do you think the stretcher would make zero difference?

	▲	captainkrtek 4 hours ago \| parent [-]
		Yes! These patients are critical and we would not let them ambulate themselves to the ambulance, we would insist on loading them and moving them ourselves to limit exertion. Extra exertion could tip them into cardiac arrest.

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amluto 5 hours ago | parent | prev [-]

Does this mean that someone having a likely heart attack should have someone drive them to an ER in advance of paramedics arriving?

	▲	captainkrtek 5 hours ago \| parent [-]
		I’d say no if it were my family, and I know the response times in my area, but the story in the blog is a nightmare scenario. People can go from heart attack to cardiac arrest quickly, and you don’t want to then tell medics you’re on the freeway and now need to do CPR. See: https://m.youtube.com/watch?v=mxUqHwHbNtk&t=1520s Around the 11 minute mark this man went into cardiac arrest, a moment prior was still talking.