One of the most important things we do in EMS is to evaluate patients having non-STEMI chest pain. In our protocol at the Columbus Division of Fire, we are to suggest and offer transport to the hospital for anyone who is experiencing or has had recent onset of chest pain. This is in our protocol because there are several causes of chest pain that are life-threatening and require emergent medical evaluation and treatment in a hospital setting.

There are several things to keep in mind in evaluating the patient whose presenting complaint is chest pain. First, the patient will usually want you to tell them the cause of their chest pain is not their heart. In fact, if they are reasonably rational and not hypochondriacs, they will look to you, as the most experienced and knowledgeable medical expert at their immediate disposal, in hopes that you will be able to determine there at the scene that their chest pain is just indigestion or some chest wall pain. Unfortunately, you do not have the proper tools at your disposal to make that determination. Though you can do a 12-lead EKG, even if that shows no obvious sign of myocardial infarction, that does not rule out the possibility the patient is having a heart attack, aortic dissection, pulmonary embolus or pericarditis. The whole expression "chest pain" is really up to the patient's interpretation. What is actually "pain"? For example, a patient having chest pain may say, "Well, it's really not a pain, but more like a pressure." Or they may describe it as a discomfort, misery, burning, tightness, piercing or just an unsettled feeling in their chest. Sometimes the pain is not even in their chest but in their jaws, shoulders, back or epigastric area. Any of these cases could have a cardiac source until proven otherwise.

The manner in which feedback is conveyed to the patient is extremely important. You have to be very deliberate and clear as you explain the severity of their condition to them. If they only hear things like, "Well, I don't see anything obvious on your EKG," then they will hold on to that statement and ignore the other things you say, like, "But we can't be sure unless you go with us to the hospital." The way in which you communicate your findings to chest pain patients is crucial to their ultimate decision to be transported. Remember, your goal is to get them safely to the hospital, so they can receive further evaluation.