Background Chest pain is a common cause for contacting the EMS, representing 10–15% of all EMS missions. Within this group only 15% suffer from a high-risk condition. It is an important, but challenging, task to identify these patients in need of prompt hospital care.

Objective To identify prehospital predictors of high-risk conditions among EMS patients with chest pain.

Methods We prospectively included 2917 consecutive EMS missions concerning patients with chest pain. Data regarding, medical history, symptoms, vital parameters and troponin were collected. All patients were classified as having high-risk condition or not. High-risk condition was defined as a time-sensitive diagnose with high mortality rates in need of immediate care (based on diagnose on hospital discharge).

Results In total 16% of included missions concerned a patient with a high-risk condition. In total 24 factors showed significantly increased odds of having a high-risk condition (table 1). Several factors also predicted lowered odds of high-risk condition.

Conclusions Several factors available in the prehospital setting seem to be suitable for risk assessment of patients with chest pain. Combing these factors in a scoring tool might be a feasible way to improve prehospital risk assessment.