by Carolyn Thomas ♥ @HeartSisters
I don’t know why this even needs saying, but apparently it does. People talking about heart patients with severe chest pain (or offering advice to heart patients with severe chest pain, or speaking onstage at Stanford University’s Medicine X conference showing this dreadful slide about heart patients with severe chest pain) must never – and I do mean NEVER – even hint that patients should drive themselves to hospital while experiencing “severe chest pain” unless you are “too dizzy to drive yourself”.
REALITY UPDATE: I am posting this slide as a warning to others about giving bad advice, not to offer an opinion on hospitals that invest in patient communication tools, unless you are the hospital responsible for sending out that boneheaded text on the above slide.
My immediate response while watching the livestreamed MedX presentation of the speaker who showed this slide (after standing up and yelling at my screen) was to contact her, begging her to delete it from all future presentations. I did not hear back from her.
But in case you’re wondering, nobody experiencing “severe chest pain” should be told by any person working in health care to drive themselves to the E.R.
I find this slide exasperating, especially since this speaker’s content was clearly not vetted by Stanford University, and even more so given the amount of time I devote here on Heart Sisters and during my women’s heart health presentations to urging my audiences and readers NOT to drive themselves to hospital if they believe they’re experiencing cardiac symptoms.
Remember this: chest pain is a sign from Mother Nature telling us not to get behind the wheel.
I’m especially testy about this issue because I too was one of those ill-informed people who got into my little green car at the airport and drove for miles ON THE HIGHWAY despite textbook heart attack symptoms that were so bad I couldn’t walk more than five steps. The only reason that I survived driving myself around town in mid-heart attack was that it was approximately 2:30 a.m. and there were no other cars on the road (at least, from what I remember. . .)
Despite my do-what-I-say-not-as-I-did urging, we know that the reality of how heart patients are actually making their way to the E.R. while experiencing cardiac symptoms is quite dismal. One Irish study found that only 63 per cent of women (and 60 per cent of men) traveled by ambulance.
And now, we have several hundred people attending Medicine X in person, and countless others like me around the world watching this speaker’s unfortunate slide via livestream coverage who are now being told it’s acceptable – even recommended – to drive yourself, along with this odd disclaimer:
- severe chest pains = okay to drive
- dizziness = not okay to drive
NO! Neither of these conditions mean you should drive yourself.
As reported in the Wall Street Journal (full disclosure: an article that also includes an interview with me), the Yale Heart Study found that 13 per cent of people experiencing heart attack symptoms drove themselves to hospital, and a whopping 41 per cent reported that someone else drove them to Emergency.
One of the women in my Heart-Smart Women presentation audiences told me that she had taken the bus to hospital during her heart attack!
Please. Do not do this.
Why don’t all people call 911 during a heart attack? According to Dr. Angelo Alonzo of the Yale Heart Study, some patients said they were worried about the cost of ambulance; others said they would be embarrassed to have neighbours see them taken away on a gurney by paramedics.
Many of the heart patients interviewed in the Irish study told researchers that they were “too embarrassed to go in an ambulance”, or that “they should only be used for more urgent cases”. See also: Fewer lights/sirens when a woman heart patient is in the ambulance
What’s wrong with getting somebody else to drive you to the E.R?
Glad you asked. We don’t generally recommend that you ask/allow somebody else to drive you to the E.R. during severe heart attack symptoms, unless absolutely necessary (a very rare occurrence, i.e. you’re in such an isolated rural area that waiting hours for the closest ambulance to drive all the way to fetch you might actually be more dangerous than arranging your own transport).
And if you’re a worried, distracted spouse at the wheel, you may find it impossible to focus appropriate attention on the road instead of on the person sitting next to you, slumped in the passenger seat in mid-heart attack.
Illinois cardiologist Dr. Irving Schwartz once told an NBC interviewer that his local ambulance service is actually under-used during heart attack situations. He described some of the resulting problems he’s observed during his career:
“I’ve seen people who drive themselves in and just as they get to the door of the E.R., they collapse. Or they collapse on the way if someone else drove them in – they’re in cardiac arrest before they got there. All of that could usually have been averted if they simply called 911.”
Similar observations were also found in a Canadian study presented at the Canadian Cardiovascular Congress. The lead author of the study, Dr. Madhu Natarajan, a cardiologist at the Hamilton Health Sciences Centre, explained his findings like this:(1)
“When it comes to heart attacks, every second counts. The faster you get to the hospital, the faster you get treatment.
“But we saw that for people who came in by self-transport, their time to treatment was much longer. We’re talking about patients who have full-blown, severe pain, yet they’re trying to find their own way to the hospital. They are committing a mistake with potentially grave consequences.”
He also said people who come to hospital under their own steam can run into unexpected and dangerous delays including traffic jams, difficulty finding the ER, lineups once they arrive, and the time it takes to be assessed by a triage nurse.
Calling 911 for help also has some important advantages over self-transport if you’re in mid-heart attack. Paramedics can perform CPR or use a defibrillator in case of cardiac arrest, start an I.V. and give medications. (In Dr. Natarajan’s study, for example, patients experiencing a heart attack who drove themselves (or had friends or family members drive) waited up to 86 minutes to receive a clot-dissolving drug, compared to as few as 26 minutes for those who arrived at the E.R. via ambulance).
First responders can also hook up an EKG (electrocardiogram) to gauge the extent of heart damage and then warn the hospital in advance to have the appropriate equipment and staff ready for the ambulance arrival.
All of these advantages can significantly affect the all-important early hours of a heart attack, that time between when a heart attack patient first arrives and the time cardiac treatment is provided.
The bottom line: pay absolutely no attention to people like the woman presenting that slide at the 2016 Medicine X conference, the one who suggested you should drive yourself to the E.R. despite severe chest pain. Instead, call 911 to seek expert and immediate care if you’re experiencing heart-related symptoms like the ones below:
NOTE FROM CAROLYN: I wrote much more about recovering from many types of heart disease in my book, “A Woman’s Guide to Living with Heart Disease” . You can ask for it at your local library or favourite bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from Johns Hopkins University Press (and use their code HTWN to save 20% off the list price).
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Q: Have you ever driven yourself or somebody else to the E.R. during a heart attack?
See also:
Knowing & Going: Act Fast When Heart Attack Symptoms Hit
How Can We Get Heart Patients Past the E.R. Gatekeepers?
Too Embarrassed to Call 911 During a Heart Attack?
Downplaying Symptoms: Just Pretend it’s NOT a Heart Attack
Slow-Onset Heart Attack: the Trickster that Fools Us
Getting Help During a Heart Attack: ‘Delayers’ vs ‘Survivors’
How Women Can Tell if They’re Headed for a Heart Attack
How Does It Really Feel to Have a Heart Attack? Women Survivors Tell Their Stories
(1) Oral presentation by Madhu Natarajan, MD at the Canadian Cardiovascular Congress, Toronto, October 2008.
Heart Sisters 
2 days post contraceptive injection, I had an ‘anxiety attack’ diagnosis by a paramedic and was reassured. A flight 2 days later and a Deep Vein Thrombosis followed. Missed early opportunity to prevent DVT. I’d like to see some research on this.
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Well now. I had my husband drive me to the ER with the first heart attack because I didn’t know that it was a heart attack. We were given the “come to Jesus” talk about calling 911 next time. (you ask…what next time, eh). Five stents to two arteries that were spontaneously 100% blocked.
The next time happened 9 months later. Called 911 and the paramedics arrived within 4 minutes. Then proceeded to argue with me, my husband and adult daughter that I was not having a heart attack….they determined that it was an anxiety attack. My daughter called my cardiologist (who was out of town) and spoke with the on-call cardiologist who repeatedly stated, “She is in good hands” while refusing to speak to the paramedic.
Things heated up and the two adult men looked like two elk in a rutt (total standoff), before the paramedic asked if I could get on the gurney. My husband left for the hospital as the paramedic wheeled me out the door. …only to stop on the sidewalk and tell me that he intended to complete his chart notes before taking me to the hospital because I am “only having an anxiety attack”. We sat in the ambulance in front of my home while he picked up his clipboard and proceeded to do his charting. He spoke to himself when he did it – something to the effect that the ambulance is his safe place where people don’t tell him what to do. It was about this point that I realized that I was in DEEP trouble and may well die contained in a metal box and no one could hear a scream for help. No cell phone. Just locked in a box with a dangerous person who had no concern for me whatsoever. I told him that I may well be dead in 5 minutes and he told me that he has seen many dying people and I don’t look like a dying person.
I vomited, then turned my head again and vomited onto his clipboard. I knew it was a blockage to the LAD. He placed an IV and we simply drove to the hospital. Unfortunately, when he called it in to the ER, he told them that he was transporting a women with an anxiety attack. When we arrived at the ER, I was on the gurney in the hall as they process the transfer (16 minutes)…all that while the nurses were commenting on my monogrammed pajamas. They finally hooked me up the EKG and found the STEMI. Things started to happen at that point. Two stents to the LAD. Lost a lot of heart tissue, thanks to the paramedics’ willful negligence.
The paramedic told my husband that I needed to contact the fire department with a doctor’s note explaining that I am a high risk cardiac patient so that the next time there is a call, then they will take it seriously.
A month later, the Mayo Clinic diagnosed SCAD…spontaneous coronary artery dissection. I may look like a Ferrari, but I have a shot Volkswagen engine under the hood. Image is everything and it’s very dangerous when you look healthy.
So, lessons learned – if you have a complicated medical situation, best to report yourself with a doctor’s note so that you are a known person to the 911 system. Carry the doctor’s note with you. Mine says to transport me to the nearest cath lab without delay. I will call 911 next time, but I also ask a back up person – neighbor/family, etc.
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OH FOR GOD’S SAKE!!!! In what parallel universe is a paramedic given the power to diagnose or misdiagnose a heart patient with SCAD? No heart patient (especially one already living with a confirmed diagnosis) should have to present a freakin’ doctor’s note to the ambulance staff like an incompetent school child who cannot be trusted to tell the truth about her medical history! Does your hubby need a doctor’s note to prove to paramedics next time that he too is telling the truth about his wife’s cardiac condition?
I hope you reported that nincompoop paramedic to the appropriate authorities and that he has been suitably disciplined (i.e. fired).
And congratulations for vomiting on his clipboard (that was the only good part of your story!)
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The paramedic was reported to the city fire chief who replied something to the effect that it was a “union issue”. I told the chief that they need to audit his response record to determine whether or not he has an abnormally high death rate on his watch. He has no business being around incapacitated people. He continued to be employed in his position.
I spent months interviewing attorneys and found that unless you die then it’s impossible to determine exactly how much of the damage was caused by the heart attack vs the damage caused by wilful negligence. No attorney wanted to take on the expense of prosecution.
So, yes, the paramedic continued to work for the city and nothing, to my knowledge, was done. However, the same paramedic is now dying of brain cancer so I guess it all ended up in much higher hands.
The important lesson is that you need to be prepared with a primary plan and a back up plan…and do not trust someone else with your health.
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Thanks for that update, Anne. I’m sorry about the paramedic’s brain cancer, and I hope his paramedic colleagues who transport him to hospital haven’t felt the need to argue with him or his family about whether his condition is serious or not.
The tragic lesson from your example is that calling 911 and dealing with the paramedics who arrive because of that call ARE the steps we’ve been taught to do when we’re in trouble. These are the people we do trust to help us, not to engage in “wilful negligence” just because they have the ability to flex their power muscles by refusing whomever they wish to refuse.
How tragic that you have to die first before people like that are held accountable! I know many paramedics and I honestly can’t even imagine them engaging in that kind of inhumane behavour towards a patient in crisis!
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I had been having symptoms of a heart attack for almost 6 months and my DOCTOR said it was nothing and sent me to physical therapy …..I think you know how this story goes from here.
I was driving home from visiting my daughter at the hospital…started to have the pain again..BUT I KNEW something was wrong and yes I kept right on driving back to the hospital….and in this instance it was a good thing, I was having a heart attack, 90% blockage to the LAD and 2 more stents besides that one……
I was 47, a CNA, thin as a rail, as I had been all my life, and no high blood pressure, no family history of early heart disease.
When I got to the hospital I didn’t stop at reception I walked right into the back to the ER and thank God they took me seriously. Within 30 minutes I was in the cath lab. Do I advise women to drive to the hospital? NO, NO, NO… call an ambulance, think of it as a mini hospital on wheels
My own doctor didnt take it seriously, I had to.
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Yikes, what a story, Donna. You and I made the same choice (driving despite heart attack symptoms) and lucked out because we didn’t smash into another car and kill ourselves or any innocent pedestrians while doing it. I like your description of the ambulance as a mini-hospital on wheels.
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Are there any cardiology devices that should be included in a first-aid kit and which could help to easier diagnose and help for a person experiencing heart attack?
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None of the devices listed in the commercial website link you forwarded belong in a first-aid kit (e.g. vascular grafts, stents, diagnostic catheters).
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Great article. I can only speak from experience living in the UK, but if in doubt call an ambulance — not only can they ensure you remain stable, but you will be seen at the ER faster as it will bypass triage, and the paramedics will have informed the hospital that you are coming, to make space for you, what your baseline ECG looks like etc.
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Exactly! 🙂
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No. But I almost did. I was having pretty scary chest “discomfort” in my PC Dr.’s office. I had been telling her about my recent symptoms when they started again. I asked her if I should go to the ER. She said “Yes. If you go in with chest pain you’ll probably get a stress test faster”. I left in a bit of a panic state. Luckily, I couldn’t find my parking ticket. I went back up to her office, and that’s when they said “We’re going to call an ambulance for you”. I was going to ask for one at that point anyway as true panic was setting in. I made it to the ER where they determined I had a heart attack with a 99% blocked LAD artery. Still feels surreal.
So please please please call 911!! The “what ifs” still linger in my mind.
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Carol, I’m surprised that your doctor didn’t suggest calling 911 right off the bat. Here’s a “what if?” question that struck me first: What if you had found your parking ticket? You’d be in your car driving yourself to the E.R. in mid-heart attack.
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My father died because he attempted to drive himself to the hospital during a heart attack – stopped at a red light and never started again, even though there was a doctor in the car behind him. UNBELIEVABLE anyone associated with caring for heart patients would suggest driving oneself to the hospital or anyone else while experiencing the pain and anxiety of a suspected heart attack!
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My condolences on your loss, Holly. What a tragic incident. I hope others reading your story will learn a priceless lesson and prevent it happening to anybody else. Thanks so much for sharing your Dad’s story.
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It’s a great idea if the ambulance arrives in a timely manner. We’ve been advised to ask for the fire department as well as the ambulance. We only have 3 ambulances in Surrey and it takes them too long.
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Thanks for that comment, Wanda. Where I live, fire trucks are automatically dispatched as first responders to all potential ‘life support’ 911 calls. They often arrive before the ambulance does. And firefighters are well-trained in emergency protocols. During one of my trips to the E.R. I had an IV placed by an out-of-town firefighter who was doing advanced training there!
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Hear hear! Call 911!
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YES! Good advice, Dr. Anne!
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