PMID- 37459650
OWN - NLM
STAT- MEDLINE
DCOM- 20231102
LR  - 20231102
IS  - 1545-0066 (Electronic)
IS  - 1090-3127 (Linking)
VI  - 27
IP  - 8
DP  - 2023
TI  - Prehospital Chest Pain Management: Disparity Based on Homeless Status.
PG  - 1101-1106
LID - 10.1080/10903127.2023.2238309 [doi]
AB  - BACKGROUND: People experiencing homelessness may use emergency medical services 
      to access health care. We sought to examine the relationship between homelessness 
      and prehospital evaluation and treatment of chest pain. METHODS: We obtained 2019 
      data of all emergency medical services activations from a single 9-1-1 provider 
      in San Francisco, California with a clinician's primary impression of chest pain. 
      Using chart review, we categorized patients as experiencing homelessness or not 
      and determined treatment rates between the two groups based on local chest 
      pain/acute coronary syndrome protocol. We then stratified the two groups based on 
      primary impression subcategories: "chest pain-not cardiac" and 
      "chest-pain-cardiac/STEMI"; ST elevation myocardial infarction (STEMI). RESULTS: 
      A total of 601 chest pain calls were analyzed after excluding non-transports and 
      pediatric patients. 120 incidents (20%) involved patients experiencing 
      homelessness. Across all chest pain impressions, people experiencing homelessness 
      were less likely to receive aspirin (35% vs 53%; p < 0.001), intravenous access 
      (38% vs 62%; p < 0.001), and nitroglycerin (21% vs 39%; p < 0.001). No patients 
      experiencing homelessness received analgesic medication, though only 4% of other 
      patients received this intervention (0% vs 4%; p = 0.020). People experiencing 
      homelessness were more likely to receive a clinical impression of "chest pain-not 
      cardiac" compared to "chest pain-cardiac/STEMI" (68% vs 32%; p < 0.001). Results 
      were less significant in most fields when adjusted for impression sub 
      categorizations: "chest pain-not cardiac" versus "chest pain-cardiac/STEMI." 
      Greater than 97% of all patients received 12 lead electrocardiograms. 
      CONCLUSIONS: Significant disparities were observed between patients experiencing 
      and not experiencing homelessness in the prehospital treatment of chest pain. 
      Larger scale evaluations are needed to further assess potential disparities in 
      care for people experiencing homelessness in the prehospital setting. Using 
      prehospital clinician impression as a proxy for acuity may mask existing bias and 
      disparity; however, 12-lead ECG acquisition, the key diagnostic tool, was 
      appropriately performed in more than 97% of all chest pain patients.
FAU - Curtis, Travis M
AU  - Curtis TM
AUID- ORCID: 0000-0002-6683-0387
AD  - Albany Medical College, Albany, New York, USA.
FAU - Boozarpour, Omid
AU  - Boozarpour O
AD  - UCSF School of Medicine, San Francisco, California, USA.
FAU - Rebagliati, Daniel E
AU  - Rebagliati DE
AD  - Albany Medical College, Albany, New York, USA.
FAU - Colwell, Christopher B
AU  - Colwell CB
AD  - Department of Emergency Medicine, UCSF School of Medicine, San Francisco, 
      California, USA.
FAU - Dailey, Michael W
AU  - Dailey MW
AUID- ORCID: 0000-0002-2160-3308
AD  - Department of Emergency Medicine, Albany Medical College, Albany, New York, USA.
LA  - eng
PT  - Journal Article
DEP - 20230809
PL  - England
TA  - Prehosp Emerg Care
JT  - Prehospital emergency care
JID - 9703530
SB  - IM
MH  - Humans
MH  - Child
MH  - *Emergency Medical Services/methods
MH  - *Myocardial Infarction/diagnosis
MH  - *ST Elevation Myocardial Infarction
MH  - Chest Pain/therapy/diagnosis
MH  - Electrocardiography
MH  - *Ill-Housed Persons
EDAT- 2023/07/17 19:08
MHDA- 2023/11/02 12:45
CRDT- 2023/07/17 17:43
PHST- 2023/11/02 12:45 [medline]
PHST- 2023/07/17 19:08 [pubmed]
PHST- 2023/07/17 17:43 [entrez]
AID - 10.1080/10903127.2023.2238309 [doi]
PST - ppublish
SO  - Prehosp Emerg Care. 2023;27(8):1101-1106. doi: 10.1080/10903127.2023.2238309. 
      Epub 2023 Aug 9.