Ambulance ramping and patients with cardiac‐type symptoms: understanding the unloading queue

Prioritisation for unloading, once obvious cardiac emergencies have been excluded, disadvantages women and older people

About 10–20% of people transported by emergency ambulance to hospital have (presumptively cardiac) chest pain.1 Our management of these patients is inevitably geared to the possibility of evolving myocardial infarction, in which case any delay in initiating definitive treatment to restore coronary perfusion will increase the short and long term risks of death.2 The three major sources of delay after the ambulance collects the patient are the time taken to deliver the patient to a suitable hospital, the waiting period outside the emergency department before unloading the patient, and within‐hospital barriers to treatment initiation, such as delays in definite diagnosis and the availability of suitably trained staff for delivering definitive treatment. For most purposes, it is best to consider barriers to treatment as a “series resistance model”: what ultimately matters is to ensure that treatment is delivered as expeditiously as possible.