Background: Pre-hospital care for patients from suffering acute coronary syndrome (ACS) has been shown to be a challenge. Associated symptoms appear together with typical ones. The symptoms have been reported to be more intense in the pre-hospital setting than after hospital admission. Special education could benefit for ambulance nurses (AN).

Purpose: A. To describe the prevalence of dyspnea and nausea or vomiting and their associa­ tion with outcome. B.To explore the possible connection between the patients' estimated inten­ sity of pain before arrival to the hospital and clinical findings. C. To evaluate the possible effect of education in cardiovascular nursing on pain intensity in patients suffering from suspected ACS.

Methods:  A randomised controlled trail: an educational and a medical intervention. There is also a retrospective design. In the trial: The inclusion criteria were symptoms of pain 4 on the coloured analogue scale raising suspicion of ACS. In total 1,603 patients participated. The edu­ cational intervention was a course including care assessment and treatment as well as clinical cardiology. The medical intervention was Midazolam.

Results: A. One in three patients has symptoms of dyspnea and the same number of patients has symptoms of nausea or vomiting, which increases the suspicion of ACS. B. More intensive pain was associated with: 1) lower age and a higher prevalence of previous smoking; 2) more complications before hospital admission in terms of hypotension and  AV-block-  bradycardia which required treatment and 3) a higher incidence of heart failure, anxiety, and pain after hos­ pital admission that required treatment. C. On admission to hospital, the pain score was signifi­ cantly lower for patients treated by an AN with special education compared with those treated by an AN without such education. The AN with special education used higher doses of mor­ phine to treat patients.

Conclusion: An assessment and treatment strategy that combines all symptoms, both the typical symptoms and the associated ones, is needed. The estimated in­ tensity of pain can predict outcomes. The possible effect of special education for ANs is shown but needs to be confirmed in further trials.