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The barriers associated with emergency medical service use for acute coronary syndrome: the awareness and influence of an Australian public mass media campaign
  1. Susie Cartledge1,2,
  2. Judith Finn1,3,
  3. Lahn Straney1,
  4. Phillip Ngu2,4,
  5. Dion Stub1,2,4,5,
  6. Harry Patsamanis6,
  7. James Shaw1,2,
  8. Janet Bray1,2,3
  1. 1 Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
  2. 2 Alfred Health, Victoria, Australia
  3. 3 School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Western Australia, Australia
  4. 4 Baker IDI Heart and Diabetes Institute, Victoria, Australia
  5. 5 Western Health, Victoria, Australia
  6. 6 National Heart Foundation of Australia, Victoria, Australia
  1. Correspondence to Ms Susie Cartledge, Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, Level 6, 99 Commercial Road, Melbourne, Victoria 3004, Australia; susie.cartledge{at}


Background Emergency medical services (EMS) transport to hospital is recommended in acute coronary syndrome (ACS) guidelines, but only half of patients with ACS currently use EMS. The recent Australian Warning Signs campaign conducted by the Heart Foundation addressed some of the known barriers against using EMS. Our aim was to examine the influence of awareness of the campaign on these barriers in patients with ACS.

Methods Interviews were conducted with patients admitted to an Australian tertiary hospital between July 2013 and April 2014 with a diagnosis of ACS. Patient selection criteria included: aged 35–75 years, competent to provide consent, English speaking, not in residential care and medically stable. Multivariable logistic regression was used to examine factors associated with EMS use.

Results Only 54% of the 199 patients with ACS interviewed used EMS for transport to hospital. Overall 64% of patients recalled seeing the campaign advertising, but this was not associated with increased EMS use (52.0%vs56.9%, p=0.49) or in the barriers against using EMS. A large proportion of patients (43%) using other transport thought it would be faster. Factors associated with EMS use for ACS were: age >65 years, ST-elevation myocardial infarction, a sudden onset of pain and experiencing vomiting.

Conclusion In medically stable patients with ACS, awareness of the Australian Warning Signs campaign was not associated with increased use of EMS or a change in the barriers for EMS use. Future education strategies could emphasise the clinical role that EMS provide in ACS.

  • Acute coronary syndrome
  • emergency medical services
  • ambulance
  • decision making

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  • Contributors JB, SC, DS, JS and JF conceived and designed the study, and contributed to the ethics committee (Institutional Review Board) application. JB and JF supervised the overall study. SC and PN collected all data. SC and JB cleaned and formatted the data. SC, JB and LS undertook the data analysis. All authors contributed to interpretation of the results, and drafting and revision of the manuscript. JB takes responsibility for the paper as a whole.

  • Funding This study was commissioned by the Heart Foundation. The Heart Foundation was not involved in the data collection or statistical analysis. JB, JF and SC receive salary support from the National Health and Medical Research Council (NHMRC) Centre for Research Excellence: Australian Resuscitation Outcomes Consortium (no 1029983). JB and DS are supported by a cofunded NHMRC/Heart Foundation Research Fellowships. JF receives salary support from St John Ambulance Western Australia. JS has no funding to declare.

  • Competing interests JB, DS and JF provide unpaid consultation to the Heart Foundation. HP is employed by the Heart Foundation. JS has no conflicts to declare.

  • Provenance and peer review Not commissioned; externally peer reviewed.