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emergency medical services, heart failure, qualitative research



  1. Jung, Miyeon PhD, RN
  2. Hays, Laura M. PhD, RN
  3. Pang, Peter S. MD, MS
  4. Newhouse, Robin P. PhD, RN
  5. Arkins, Thomas P. MHI, EMT-P
  6. O'Donnell, Daniel MD
  7. Cook, Ryan MPH
  8. Gradus-Pizlo, Irmina MD
  9. McAdams, Ellen BSW
  10. Pressler, Susan J. PhD, RN


Background: Heart failure (HF) is a common condition leading to activation of emergency medical services (EMS).


Objective: The aim of this study was to describe reasons given by persons with HF, family members, or other caregivers for requesting EMS activation during 911 calls.


Methods: In this descriptive qualitative study, a content analysis was performed on transcribed audio files of 383 EMS requests involving 383 persons with HF in the community.


Results: One hundred forty-seven calls (38.4%) were placed by the family members, 75 (19.6%) were placed by the patients, 56 (14.6%) were placed by healthcare workers or personnel from living facilities, and the remaining calls (n = 105, 27.4%) were placed by others (eg, friends, neighbors, officers). Three broad categories of symptoms, signs, and events were identified as the reasons for an EMS request. Frequently reported symptoms were breathing problems (55.4%), chest pain (18.3%), and other pain (eg, head, extremities) (16.7%). Signs included decreased consciousness (15.4%), swelling (5.7%), and bleeding (5.0%). The reported events involved falls (8.1%), heart attack (6.3%), hypoxic episodes (6.0%), stroke (5.2%), and post-hospital-discharge complications (4.7%). In most calls (74.9%), multiple reasons were reported and a combination of symptoms, signs, and events were identified. Heart failure diagnosis was mentioned in fewer than 10% of the calls.


Conclusions: Overall, symptoms and signs of HF exacerbation were common reasons to activate 911 calls. Falls were frequently reported. Under the duress of the emergent situations surrounding the 911 call, callers rarely mentioned the existence of HF. Interventions are needed to guide patients with HF and their family members to promote the management of HF to reduce EMS activation as well as to activate EMS quickly for acute changes in HF conditions.