Can paramedics avoid A&E departments with patients complaining of non-traumatic chest pain?

Chest pain is a very common complaint in Emergency Care. It is estimated that in the UK 20–30% of hospital admissions are for chest pain (Kendrick, 1997; Quinn, 2008). In 2011-2012 chest pain was the third most common reason to request an emergency ambulance in the North West, comprising 8.94% of all calls (North West Ambulance Service, 2013). As the prevalence of Coronary Artery Disease, a contributing factor to chest pain, rises (Quinn, 2008), those admissions and ambulance calls are likely to increase (Hamm et al 2011). Whether all of these patients need to be taken to Accident and Emergency can be debated.

At present, all patients in the North West of England complaining of non-traumatic chest pain should be taken to hospital. This is because the responsible ambulance trust has in place the ‘Paramedic Pathfinder’: a triage tool for paramedics (North West Ambulance Service, 2014; Newton et al, 2013). As the tool does not differentiate between pleuritic, cardiac or gastrointestinal origins of pain, many patients are, perhaps, being taken to hospital unnecessarily. The tool is therefore at odds with the current discourse within emergency care; namely to treat patients closer to home and avoid filling over-stretched Accident and Emergency Departments (Association of ambulance service chief executives (AASCE), 2011; NHS England Emergency and Urgent care review team, 2014).