Study Shows Increased Use of 911 Services Thanks to Educational Campaign

07/05/00    Portland, Ore.

OHSU Part of REACT Study Published in JAMA This Week

Oregon cities are part of a study published in the July 5 edition of the Journal of the American Medical Association. The Rapid Early Action for Coronary Treatment, or REACT, study found that more people used the 911 emergency services system as a result of a community awareness campaign about the warning signs of a heart attack. Oregon Health Sciences University was one of the Northwest sites for the study. Eugene, Springfield, Beaverton and Aloha communities all participated in the study. The primary goal of the study was to reduce patient delay from the time of the first heart attack symptom to time of treatment in the emergency department; however, the study found that human behavior is not that easily changed. People are still initially reluctant to seek medical treatment when they first experience symptoms of a heart attack.

The REACT study, sponsored by the National Heart, Lung and Blood Institute, compared 10 communities that received the public awareness campaign and 10 communities that did not. In Oregon, OHSU worked with community groups to help educate people during an 18-month period in the Eugene/Springfield area. The Beaverton/Aloha area was the control group and did not receive public education. The educational campaign in the Eugene/ Springfield area was so effective local emergency services continue to use it. OHSU coordinated the Oregon sites, while the King County Department of Emergency Medical Services in Washington coordinated the other Northwest community sites in the study.

"We didn't get our overall median patient delay time down and that was a little disappointing to us. On the other hand, we got people there by the right mode. I think that's an improvement," said Jerris Hedges, M.D., M.S., co-principal investigator for the Northwest site and chairman of the Department of Emergency Medicine in OHSU's School of Medicine. "Our public awareness campaign had to compete for the people's attention during a time when we are all overwhelmed with information."

A secondary goal of the public awareness campaign was to increase the use of ambulance services. Other studies have found that most patients in the United States come to the emergency departments on their own, rather than by ambulance.

"If the ambulance gets to you, you've got a paramedic team that can deliver medicine, oxygen and if you go into cardiac arrest they can defibrillate you. So essentially, its like bringing the hospital to the patient," said Hedges. "The sooner you receive treatment, the more likely you are to survive."

Hedges said another important aspect of the study results were even though ambulance use increased by 20 percent, they were not false alarms. Researchers were concerned that the public awareness could cause people to come into the emergency department with false alarms overwhelming the emergency system and wasting the patients time and money.

REACT is one of the first substantial studies to look at the impact of community education on the time it takes people to recognize the warning signs of a heart attack then receive medical treatment. Clinical trials for heart attack treatments have shown that the sooner you receive medical treatment the more likely you are to reduce damage to the heart and/or reduce death.

"The longer the event takes place the less likelihood of reversing it and saving muscle, and the more likelihood that they could have sudden death," said Hedges. " Most of the delay takes place not because they're waiting for an ambulance or waiting for a ride to the hospital, it's because people don't understand when their symptoms warrant the need to go to the hospital. They don't understand the disease."

The REACT study compared 20 communities around five regions of the United States. Of those, 10 cities received 18 months of intense community education. The campaign included the use of news media, advertising and direct education of patients, health care providers and the general public. In addition, paramedics gave patients positive feedback by affirming that they made the right decision to call 911. Those cities were then compared to 10 other cities of comparable size, demographics and socioeconomic status. Researchers collected data on heart attacks from hospitals in all 20 cities as well as conducting surveys of community members and heart attack survivors to determine if public awareness was increased.

The four-year REACT study started in 1994. At that time the patient delay time in all 20 cities that participated averaged two hours and 21 minutes. According to REACT investigators this was already a shorter delay time than had been found in most previous research. The patient delay in the intervention and control cities both declined during the study, but the difference between the two was not significant.

REACT researchers conclude the study results indicate a continued need for more intense education about heart attacks during a longer period of time.

The REACT study included five field centers: The University of Alabama at Birmingham, the University of Massachusetts Medical School, the University of Minnesota, the University of Texas in Houston, and a combined site at the King County Department of Emergency Medical Services in Washington and Oregon Health Sciences University. The study communities were in 10 states: Alabama, Louisiana, Massachusetts, Minnesota, North and South Dakota, Oregon, Texas, Wisconsin and Washington.