Although patients with chest pain who transport themselves to hospital may arrive at the emergency department (ED) sooner than if they used the emergency medical services (EMS), they will not receive treatment as quickly, US research suggests.

Only 50 per cent to 60 per cent of Americans with chest pain choose to initiate care using the EMS, note Caroline Hutchings (University of Utah School of Medicine, Salt Lake City) and colleagues in the American Heart Journal.

"Interestingly, one of the primary reasons cited by persons with chest pain for not calling 911 for transport to the hospital is that private transportation is thought to be quicker," they say.

To determine whether patients really did benefit from transporting themselves, the team conducted a retrospective cohort study using data from the Rapid Early Action for Coronary Treatment (REACT) trial, which was conducted at 20 US cities.

Among 2393 individuals with chest pain, the 65 per cent using private transportation arrived at the ED more quickly than the 35 per cent using EMS, at 35 versus 39 minutes (p=0.0014).

However, if EMS treatment was considered as initial care, calling 911 resulted in much quicker care than using private transportation to the ED, at 6 versus 32 minutes (p<0.001). Transportation by EMS also resulted in a shorter time to administration of thrombolysis, both when considering ED "door-to-needle" time (32 vs 42 minutes, p<0.001), and from decision to seek care until administration of thrombolytic therapy (75 vs 92 minutes, p=0.042).

"In summary, patients with chest pain correctly surmise that private transport rather than activating EMS results in a quicker trip to the ED," concludes the team. "However, when considering elapsed time to initial diagnosis, symptom management and thrombolytic administration, EMS activation proves faster."