Chest Pain, Pregnancy, And Aspirin

Brett Patterson

Brett:

I had an employee on the line with a 2nd party caller who was reporting a 37-year-old female with chest pains. Nowhere on the chest pains card do you ask if she is pregnant, yet she is of childbearing age. Critical EMD information says not to give aspirin to a person who is pregnant. How would you know unless you ask a freelance question? If someone can answer or give me some direction, I would appreciate it—thank you!

Michelle R. Aman

911 Shift Supervisor

Billings 911 Center

Billings, Montana (USA)

Hi Michelle:

The simple answer is the clinicians on the Standards Council didn’t think we needed to ask the question, so we didn’t include it in the protocol.

As you may remember, pregnancy was not a contraindication to the dispatch administration of aspirin until recently. It’s not that we didn’t know aspirin could be problematic during pregnancy; we did. But we also knew that the gestational window for potential aspirin-related complications is very small, and the odds of a single dose being problematic is extremely low. If fact, the only reason this came up for debate again was because callers were offering that the patient was pregnant, and that their doctor had told them not to take aspirin (although not specifically referring to a single dose in the presence of heart attack symptoms).

So why do we now include pregnancy as a contraindication? Although the risk of complications is extremely low with a single dose, the risk of actual heart attack in this age range is also quite low, and the emergency physicians we consulted with typically said that because the infarction risk was low, they would likely withhold aspirin until more definitive diagnostics were available, or until advised by a cardiologist.

So, rather than ask a question about pregnancy for every female in cardiac age range with heart attack symptoms, we decided not to ask the question and only stop the aspirin instructions if the caller offered that the patient was pregnant. Additionally, the early gestational window in which complications from aspirin may occur makes a question about pregnancy problematic—the patient may not know she is pregnant. So, in essence, the unreliability of the question, the low probability that the caller will offer that the patient is pregnant, and the extremely low odds of complications from a single dose justified not including a question.

Thanks,


Brett A. Patterson 
Academics & Standards Associate 
Chair, Medical Council of Standards 
International Academies of Emergency Dispatch 

Brett Patterson is Academics & Standards Associate and Chair of the Medical Council of Standards for the IAED. His role involves protocol standards and evolution, research, training, curriculum, and quality improvement. Prior to working with the IAED, he spent 10 years working in the Pinellas County EMS System, Florida. He answers members’ protocol questions in the Journal FAQ column. 

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