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).
Q: Have you ever driven yourself or somebody else to the E.R. during a heart attack?
(1) Oral presentation by Madhu Natarajan, MD at the Canadian Cardiovascular Congress, Toronto, October 2008.