Worried about a 25% decrease in the number of calls from people with symptoms of heart attacks, strokes and other serious medical issues — and a 10% increase in instances in which the patient dies before emergency medical personnel arrive — the King County Fire Chiefs organization is urging people to call 911 when needed.

In a statement posted Tuesday on its website, the fire chiefs’ association said it’s understandable people are reluctant to call 911 during the novel coronavirus pandemic but that King County’s fire departments have the resources to take care of people and the policies to protect workers. The apprehension about calling 911 could be related to fear of contracting COVID-19, the disease caused by the coronavirus, or putting a burden on emergency services, the statement says.

In the early days of the pandemic, paramedics responded to places such as the Life Care Center in Kirkland — the epicenter of the Seattle-area coronavirus outbreak — without knowing what they were walking into, Dr. Michael Sayre, the medical director for the Seattle Fire Department and Seattle Medic One, said by phone Tuesday.

But after two months battling the disease, paramedics and hospital staff are taking every precaution, including increased use of Personal Protective Equipment (PPE), to protect themselves and their patients from becoming infected, he said.

Hospital capacity also isn’t a concern right now: “We have room, we have a bed for you, our hospitals aren’t overwhelmed,” said Sayre, who is also a professor of emergency medicine at the University of Washington.

Still, Sayre noted people older than 60 — the same population most at risk of developing serious health problems from the virus — are the same people most likely to suffer a major heart attack or stroke.


The fire chiefs’ association noted particular concern about the recent decrease in calls from people having symptoms of an ST-elevation myocardial infarction (STEMI) heart attack, caused by a blockage of the coronary artery. Symptoms include chest pain, shortness of breath, sweating, nausea, vomiting, anxiety, palpitations, dizziness or lightheadedness. In King County, paramedics carry equipment on medic units to diagnose a STEMI heart attack in the field and can coordinate with the hospital so the patient receives specialty care upon arrival.

“The heart attacks that are most treatable are the ones that occur suddenly without warning,” Sayre said.

He explained that cholesterol builds up over years in artery walls and for reasons no one really understands, a crack forms in the cholesterol one day. Blood flows over the crack to seal it and a blood clot forms, which stops blood flow through the artery.

“That’s what a heart attack is and people usually feel pretty significant discomfort and describe pain or heaviness in their chest or feeling something’s not right. For many people, it’s hard to describe,” Sayre said.

Paramedics will evaluate a patient’s blood pressure and pulse, perform an electrocardiogram (EKG) in the field, and call ahead to mobilize hospital staff to prepare their cardio catheterization lab while the patient is transported, which is why it’s better to call 911 than to go to the hospital on your own, he said. Once a patient has arrived, a cardiologist will typically insert a tube through the patient’s wrist to the artery and use either a wire to poke through the clot and suck it out or pass and inflate a balloon through the clot, re-establishing blood flow.

Based on Seattle Fire Department statistics, Sayre said paramedics working in the city should have responded to 75 to 80 STEMI  heart-attack calls by this time of year, but have only seen around 50 patients, a reduction in calls that has played out across the county.


“The trends are worrisome,” said Sayre, adding a heart-attack patient has the best chance of making a full recovery if the artery blockage is removed within two hours of the onset of symptoms.

For stroke patients, who suffer blockages in arteries that carry blood to the brain, the window of time to receive treatment is even shorter since the arteries are smaller and brain tissue dies faster than heart tissue, Sayre said. Unlike heart attacks, strokes don’t cause pain but symptoms typically include weakness to one side of the body and an inability to speak.

“Their brain isn’t working right, so they need someone else to notice and take action, which is hard if you’re social distancing or if you’re alone,” he said. “If you or your loved one realizes something’s not working right, calling 911 is the best strategy.”

For best outcomes, “it really means you have to call 911 within 15 to 30 minutes” after the onset of symptoms for either a heart attack or stroke, Sayre said.

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