Ask the Experts: Early Heart Attack FAQs

Dr. Raymond BahrDr. Raymond Bahr, Chest Pain Center Founder

Dr. Bahr has served many executive roles since founding the Society of Chest Pain Centers (now ACC Accreditation Services). His Early Heart Attack Care™ (EHAC) program is a benchmark of community outreach and education for heart disease.

Q: The EHAC pledge has taken over 450,000 times … why is that number so significant?
A: Because the growth of the EHAC message by thousands is heading in the direction of viral growth to millions. It is taking off before our eyes. It is a message that all Americans need to know to protect their heart by being tuned in for early signs of heart trouble. Becoming deputized into the EHAC message allows all of us to take action.

Q: And with this momentum, where is EHAC going?
A: Nationwide … so that one day everyone in America (300 million people) will know what to do when they have the onset of chest discomfort symptoms that keep coming back. We want them to think, "This could be the start of something BIG … I need to protect my heart, because my family depends on me, and I'd rather be safe and not sorry."

Q: How can people help it go nationwide?
A: By understanding the EHAC message and helping to spread the online course. They can pass the test and become deputized into action by taking the pledge to become involved. Deputized EHAC experts know to stay involved until the person with the early symptoms is checked out in the hospital.

Q: Great, so what can accredited hospitals do now to accelerate this program?
A: By finding out their hospital's internet service (usually HealthStream) that has online competency programs and adding the EHAC module Also, by making it a required course for all hospital employees, as it is for Chest Pain Center Accreditation (Cycle IV). In a 400-bed hospital this amounts to about 2,000-3,000 employees. With 800 Chest Pain Centers in the United States, this would amount to 2-3 million EHAC deputies.

Q: What about community programs or involvement?
A: As hospitals set up Chest Pain Centers to deliver EHAC, the next step is to teach their employees why there is a Chest Pain Center in their Emergency Department. Then they will be able to teach people in their community about the EHAC way to save lives. We ask accredited Chest Pain Centers to teach their local community about important life-saving tactics. Suggestions for how to get started are included in a short five-minute course on The community approach can be enhanced by setting up EHAC training in schools in the community around the hospital.

Q: What's the ultimate goal?
A: The ultimate goal is to create communities of informed citizens and help all Americans understand how to prevent heart attacks or lessen the damage caused by heart attacks. Only then can we begin to think about reducing significantly the 800,000 heart attack deaths in the United States each year. Our mission is slowly but surely becoming a reality!

Q: Are there tools to take this outside the doors of the hospital and into the community?
A: The tools revolve around the standard EHAC course on the website. The short five-minute EHAC course can be used by staff for members of the community. This EHAC course can also be downloaded and used as handouts. Those who pass can take the EHAC Pledge and they are included in the EHAC pldege count.

Q: What is the EHAC mission and goal?
Our mission is to significantly reduce heart attack deaths in the United States and change its position as the number one cause of death in the United States - a position it has held for over 150 years. Our goal is to reduce heart attack deaths each year to half this amount (400,000 deaths).

We can do so by focusing on the 50% of the patients who start out with early chest symptoms, but don't get into the hospital soon enough. Accredited hospitals can provide a user friendly pathway for patients coming in with early heart disease symptoms. Our accredited facilities can be found on the free app "Best Heart Hospitals" and can be located on iPhones that provide directions using their GPS location.

We now have a standard way of educating the community on when to come to the hospital to be checked out. We start first by educating the hospital employees.

EHAC-trained deputies are individuals who have pledged to stop what they are doing and attend to a person in their midst who is having the early symptoms of a heart attack. Can you imagine how many lives can be saved with this army of of nearly 650,000 who are out in the community to spot such early heart attacks and are ready to act to prevent them from occurring?

We want to grow the number of EHAC-trained deputies to numbers in the 3-5 million range and hope that this will be enough to take it virally to the total American population. Then, we'll know that we have changed the culture of America and how Americans deal with the heart attack problem.

Our accreditation programs exist to remove heart attack deaths as the number one killer of the adult population in the United States. The strategy of creating increasing numbers of accredited CV facilities is working but a lot more work is needed before we can claim victory.

Q: You talk a lot about Saver or Enabler. What does that mean?
A: The bystander is perhaps the most important when someone is in the midst having a heart attack. There are three types of heart attack presentations everyone should know about.

Q: What are they?
A: There is the one that drops you dead and you have no chance at all to survive unless you can be defibrillated fast. However, if the bystander knows how to perform Cardio Pulmonary Resuscitation (CPR) there is a chance of survival.

With the second type, the patient will appear very weak and sweating cold beads across their foreheads. The person here is most likely experiencing severe pain across the chest. They will often describe it as "an elephant or Mack truck sitting on their chest". The saver knows quickly to call 911 and get an ambulance. Time is important — 80% of the heart damage will occur within the first two hours. Unfortunately, the average time to get into the hospital is about two hours and this has not changed much over the years. Even within the Hospital, the average time to open the clotted blocked heart vessel is 60-90 minutes.

The third type begins when the patient experiences "beginning mild chest symptoms" before they progress to the severe chest pain that will bring them into the hospital. It is here where the bystander or becomes either an enabler or saver.

Q: Is it really "enabling?"
A: In the first two presentations, it is obvious what is taking place and the Bystander will be usually … no getting around this. But, in the third type, the patient in the early stage will not look sick and no one will suspect that anything is taking place. The patient many times will be denying their symptoms because the "inconvenience" will ruin their day. That's when the bystander then becomes the enabler, because they behave like it's no big deal.

Q: So even "little" episodes are a big deal?
A: Heart attack is the No. 1 killer of the adult population in the U.S., because we allow it to be a crashing illness. It need not be. Everyone forgets about what is happening until it is too late. Taking action early prevent s the heart attack from progressing.

Q: So what should everyone know … the basics?
A: To save a life, overcome the resistance and struggles that the patient may throw up to avoid not going to the hospital.

Q: Yes, but how do you do that?
A: The ideal approach to intervention can be recalled through a simple acronym: SPICE which stands for:

  • simple
  • persistent
  • influential
  • calm
  • empathetic

Q: So do all that, but take action, don't wait?
A: Do not take the time to attempt an evaluation. Get them to medical care as soon as possible. Find out what they need. To be a saver, the bystander needs to interrupt their day to save the life of another … and what could be a better use of someone's time than that?