Once again I find myself taking a post length comment to an article on someone else’s blog and turning it into a post here.
Brooks Walsh over at Mill Hill Ave Command posted a new article called Gender, EMS, and STEMI – a new study
The indicated that women have longer on scene times then men when they are having a STEMI. The study drew no conclusions as to why, but Brooks brings up some good points. You should read his article, if not the original study.
I’ll add one more possible reason to his list. Women, especially elderly women, are often harder to get IVs in then men. Which would easily add another minute or two to the on scene time if you, as if sometimes the case, you need to do the IV before moving the patient.
Over the summer and fall I did a lot of reading on the subject of Women and MI. What I found is that this is well documented in the in hospital treatment setting. Not just in the US, but in many western nations.
The root of the problem is that many women do not present with what we have been taught over the years is “typical” chest pain. Women themselves, under appreciate the symptoms as they too have been taught “the classic” symptoms. Which were developed around the “typical” male, in his mid to late 50s.
Since women perceive pain differently and often don’t have “chest pain” per se, they don’t paint the picture that most of us have come to expect.
Did I mention that women tend to have NSTEMIs more than men?
Women also to have their first cardiac events at an older age than men. Sadly, their outcomes are often worse.
So, a lot of women with MIs get missed in the field, in the EDs, and in the units.
All of which is to say that the researchers are looking at the wrong things. The issue shouldn’t be why we have longer scene times, but are we as suspicious of ACS in women as we are in men. From my experience the answer is no and the studies on the subject suport that.
What to do?
Start by teaching that not all ACS events have chest pain and change protocols to reflect that.
I know of many cases where smarmy doctors condescendingly told paramedics that they shouldn’t have to given NTG because the patient didn’t have chest pain. Apparently the term “Anginal Equivalents” never came up at the mail order medical schools some EM physicians seem to have gone to. I guess they never covered that at the prestigious “Close Cover Before Striking” Medical School and Barbershop.
If you’re not looking for it, you’re not going to see it. If you’ve been told since about day seven of EMT school that all MI patients have substernal chest pain with radiation to the arm and jaw, you aren’t going to be looking for Acute Cardiac Syndrome symptoms in a 70 year old lady who tells you she just gets tired easily and wonders if she’s anemic.
Not that I’m advocating putting the monitor on every little old lady that calls for an ambulance. What I am advocating is listening to the story the lady tells you and pay heed to things like “I get tired climbing stairs”, “I got sweaty and started to throw up”, and my favorite “I just don’t have any energy to do the things I used to do”.
Any of those should make your spidey sense tell you that there might be more to the story than you initially.
Oh and one more clinical pearl before I shuffle off for a long winter’s nap.
If the lady has shortness of breath, but has never smoked, has never had Asthma or COPD, and isn’t on any medications for respiratory ailments, it’s unlikely that she suddenly developed Asthma as 0300 in the morning.