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113 Training emergency medical staff to appropriately handle patients with chest pain

Coronary artery disease(CAD) is a common cause of morbidity and mortality in the world and many patients with CAD present with chest pain in an emergency setting as a first presentation. In emergency settings in India, the burden of diagnosis and treatment of patients with chest pain often falls on the emergency physician alone, who also has to deal with other life threatening conditions at the same time. Thus, many acute presentations of chest pain can be missed or not receive the necessary treatment on time, in a busy, understaffed department. This significantly increases the mortality and future morbidity due to delays in the healthcare service provision to the patient. One way to mitigate this is by training healthcare workers like Nurses, paramedics and other emergency healthcare staff to appropriately categorise a patient with chest pain as emergent and requiring ECG, so that the investigations needed can be carried out before the physician is able to clerk the patient. This project was carried out in a tertiary care centre in Bangalore Urban, Karnataka India. First, the number of patients presenting with chest pain to the emergency department in a one-week setting were reviewed according to severity of symptoms using a 1–10 pain scale, other associated symptoms and presence of comorbidities or risk factors for Heart and lung diseases. The response time of the emergency staff to the patient from entry to the facility until appropriate management (shift to Intensive care unit, higher center referral, immediate prophylaxis, discharge) given was measured. A teaching session was conducted by emergency physicians involving all emergency staff following this. Using the data collected, a simple algorithm was devised to help staff make decisions regarding the treatment protocol. Training regarding reading an ECG, immediate prophylaxis for STEMI/NSTEMI patients and respiratory causes of chest pain was given to Nurses and senior Emergency non-medical staff.