The What and Why of Early Heart Attack Care

Dr. Raymond Bahr is the founder of the Early Heart Attack Care (EHAC) program and the Society of Cardiovascular Patient Care (now ACC Accreditation Services). His program has become a benchmark of community outreach and education for heart disease. Central to the program is the EHAC Pledge.

EHAC Pledge

"I understand that heart attacks have beginnings that may include chest discomfort, shortness of breath, shoulder and/or arm pain, and weakness.

These may occur hours or weeks before the actual heart attack.

I solemnly swear that if it happens to me or anyone I know, I will call 9-1-1 or activate our Emergency Medical Services."


By understanding the EHAC message, individuals become "deputized" into action. Deputized EHAC experts know to stay involved until the person with the early symptoms is checked out in the hospital.

ACC Accredited hospitals are expected to teach people in their community about the EHAC way to save lives. This can easily be done by using the short, 5-minute course found on the Deputy Heart Attack website. We encourage you to provide EHAC training at schools in the communities near your hospital. The short, 5-minute EHAC course can also be downloaded and used as handouts. Those who pass the course can take the EHAC Pledge and add their names to the ever growing EHAC count.

The mission of the American College of Cardiology is to transform cardiovascular care and improve heart health. Our efforts are aimed at significantly reducing heart attack deaths in the United States and at eliminating heart disease as the number one cause of death – a position it has held for over 150 years. Educating the public about heart attack symptoms, and encouraging anyone who suspects they are experiencing chest pain to get treatment immediately is key to improving the odds of surving a heart attack. Over 800 hospitals in the United States have now earned a Chest Pain Center accreditation. These centers can be found on the free app "Best Heart Hospitals" and can be located on smart phones that provide directions using their GPS location.

To remove heart attack deaths as the number one killer of the adult population in the United States is the reason why the Chest Pain Centers came into being and why we continue to carry out this plan of action. This strategy is working, but a lot more work is needed before we can claim victory.


Recognizing the importance of bystanders in the heart attack scenario

There are three types of heart attack presentations everyone should know about. These include:

  1. An individual in distress suffers massive heart attack resulting in "death", an event which, sadly, means the distressed individual will not survive unless defibrillated fast. However, if the bystander knows how to perform Cardio Pulmonary Resuscitation – CPR – there is a chance of survival.
  2. An individual in distress appears very weak and sweating – picture cold beads across their foreheads. The person 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.
  3. An individual in distress experiences "beginning of 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.

In the first two presentations, it is obvious what is taking place and the bystander will usually know how to react. 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 the distressed indivudal behaves like there's no big deal. But, even "little" episodes are a big deal! 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.

To save a life, overcome any protests voiced by the distressed individual who would prefer to avoid a trip to the emergency department.

The ideal approach to intervention can be recalled through a simple acronym: SPICE, which stands for:

  • simple
  • persistent
  • influential
  • calm
  • empathetic

And finally, don't delay! Get the distressed individual medical care as soon as possible. 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?