Chest Pain Phone Triage

On the phone you can’t examine the patient or get an EKG, so the job is to gather the story carefully, run it through this decision flow, and land on a safe disposition — not to diagnose. When in doubt, treat it as cardiac and send to the ED.

• •Is the pain happening RIGHT NOW? How long?
• •Pressure/tightness/squeezing vs. sharp? Radiating to arm, jaw, back?
• •Associated: sweating, nausea, shortness of breath, lightheadedness?
• •Brought on by exertion, relieved by rest?
• •History: prior MI, stents, known heart disease, diabetes?

• •Active chest pressure with sweating, nausea, or shortness of breath.
• •Pain radiating to the arm/jaw, or with a feeling of doom.
• •Pain plus fainting, severe dyspnea, or looking/sounding very unwell.
• •Tearing chest/back pain (possible dissection).

1. 1.Safety screen FIRST: is the pain happening now WITH any red flag (sweating, shortness of breath, radiation to arm/jaw, fainting, tearing pain, or looks/sounds very unwell)? → Call 911 / go to the ED now. Stop here.
2. 2.If not an immediate emergency, gather the full story (timing, character, exertional or not, associated symptoms, cardiac history, home vitals if available).
3. 3.Apply the disposition (below).
4. 4.The "not improving" rule: if chest pain is ongoing and not resolving or improving → advise the ED.
5. 5.The concern override: if the story, the symptoms, or the home vitals worry you → advise the ED, even if no single red flag is "checked."
6. 6.Communicate, give return precautions, document, and notify the provider per your workflow.

• •Emergency (911/ED now): active pain with red flags, or pain not improving/resolving.
• •Urgent (ED or same-day in-person evaluation; provider notified): recent or recurring pain that sounds cardiac, or a story/vitals that concern you.
• •Routine (provider callback / schedule): clearly non-cardiac and stable (reproducible, positional, tender to touch), no red flags — still route per protocol with return precautions.
• •When uncertain, default UP. On the phone, the ED is the safe choice for anything concerning.

• •For a true emergency, the patient goes to 911/ED — then notify the provider per your workflow.
• •For urgent/routine calls, send a concise note: patient ID, pain present or resolved, character + associated symptoms, cardiac history, home vitals, and your disposition.
• •Reserve interrupting the provider mid-visit for when you genuinely need real-time guidance.

• •"You’re describing chest pain with sweating — I need you to call 911 now. Don’t drive yourself."
• •"If you have aspirin and aren’t allergic, the 911 dispatcher may have you chew one."

• ☐Asked if pain is active and screened red flags first.
• ☐Directed emergencies to 911/ED without delay.
• ☐Sorted urgency and defaulted up when unsure.
• ☐Gave the provider a concise summary.