ASA Admin

The decision to have dispatchers direct callers to administer their own aspirin (ASA) is based on the AHA/HSFO Emergency Cardiac Care Guidelines. When a dispatcher asks about the problem, and the caller reports that the patient is experiencing chest pain, the dispatcher instructs the caller to take ASA—provided there is no bleeding or aspirin allergy (1).

In cases of acute coronary syndrome (ACS), the literature recommends an initial loading dose of 162 to 325 mg of ASA, administered once (2), unless contraindications are present (per the ALS PCS). Aspirin use has been shown to reduce ischemic events and the risk of coronary artery re-occlusion, with some studies suggesting a 23% reduction in cardiovascular mortality.

While ASA carries some risks—primarily gastrointestinal issues and potential for cumulative toxicity—the benefits generally outweigh these risks, even in patients with severe kidney impairment (2). The effective dose can range from 80-1500 mg, and typical doses for conditions like migraines or pericarditis are between 750-1000 mg (2, 3). The maximum daily cumulative dose is 4000 mg, though life-threatening toxicity can occur at approximately 150 mg/kg (4,5).

Current research suggests that the chewable ASA provided by your service may offer better absorption compared to the enteric-coated tablets many patients may have at home, particularly in the case of a STEMI+ ECG (6). This is an important consideration in the early treatment of cardiac events.

Based on the available information, we defer to your clinical judgment. If you determine that the patient has correctly taken their own ASA (e.g., it hasn’t expired, and they’ve chewed it as needed), you may choose to withhold an additional dose. Be sure to document your decision-making process thoroughly. However, if there is any uncertainty, it is safer to administer the medication, as ASA has a low risk and significant benefit in this context.

In any case, the additional ASA dose provided by paramedics will not exceed the recommended therapeutic dose, ensuring proper administration. Therefore, it is advisable to follow the cardiac ischemia medical directive, which supports early administration of ASA in patients without contraindications.