This indicates that the patient’s medical condition was not as severe as initially assessed, supported by our results showing that all

of these Histone Methyltransferase inhibitor patients were given a NACA-score of ≤ 3. Norwegian health authorities and cardiologists have called attention to the importance of patients calling the three digits emergency number “113″ directly when experiencing acute chest pain. Our study shows that in almost half of the calls to EMCC the call was made from health personnel, representing a possible system delay for patients with chest pain of cardiac origin in need of immediate diagnosis and treatment. Still, as the vast majority of patients with acute Inhibitors,research,lifescience,medical chest pain seem not to be in need of immediate hospital care, the primary care doctor on-call at the casualty clinic should still play an important role after the first contact to the EMCC. Primary care doctors are usually experienced in Inhibitors,research,lifescience,medical differentiating between severe and non-severe illness. As a group, they also hold a clinical background and competence making them a valuable asset in the initial management of patients with acute chest pain outside hospitals. A white paper concerning the organisation Inhibitors,research,lifescience,medical of the emergency services in Norway [17] have defined

recommended minimum requirements for prehospital response times in red response missions. An ambulance should have reached 90% of the patients within 8 minutes in urban districts, and 25 minutes in rural districts. Our results show that 87% of all patients with acute chest pain are reached within 25 minutes, but only 23% within 8 minutes. This might partly be explained by the fact that a considerable number of patients from the study population live in rural districts. But it also sheds light on the reality in Norwegian prehospital Inhibitors,research,lifescience,medical emergency medicine, which shows that we are still quite far from meeting the political aims concerning minimum requirements for prehospital response Inhibitors,research,lifescience,medical time [18].

Conclusions The majority of patients with acute chest pain were admitted to a hospital for further investigation, but only a quarter of the patients were assessed prehospitally to have a severe illness. Little is still known about the extent of patients with chest pain as their main symptom outside hospitals in Norway, including diagnostic measures, how they are treated and rates of admission to the hospital. Calpain Competing interests The authors declare that they have no competing interests. Authors’ contributions EZ and SH planned and established the project, including the procedures for data collection. RAB designed the paper, performed the analyses and drafted the first manuscript. All authors took part in rewriting and approved the final manuscript. Funding The project was partly funded by the National Centre for Emergency Primary Health Care, Uni Health, Bergen. RAB has received a research grant from the Norwegian Medical Association’s fund for Research in General Practice.