Background: People experiencing homelessness may utilize emergency medical services to access health care. We sought to examine the relationship between homelessness and prehospital evaluation and treatment of chest pain (CP).

Methods: We obtained 2019 data of all EMS activations from a single 9-1-1 provider in San Francisco, CA with a clinician’s primary impression of chest pain (CP). Using chart review, we categorized patients as experiencing homelessness or not and determined treatment rates between the two groups based on local chest pain/ACS protocol. We then stratified the two groups based on primary impression subcategories: ‘CP - not cardiac’ and ‘CP - cardiac/STEMI’.

Results: 601 CP calls were analyzed after excluding non-transports and pediatric patients. 120 (20%) of all CP incidents involved patients experiencing homelessness. Across all CP impressions, people experiencing homelessness were less likely to receive aspirin (-18%; 95% CI -27% to -8%), IV access (-24%, 95% CI -33% to -14%), and nitroglycerin (-18%, 95% CI - 26% to -9%). No patients experiencing homelessness received analgesic medication, though only 4% of other patients received this intervention (-4%, 95% CI -7% to -1%). People experiencing homelessness were more likely to receive a clinical impression of ‘chest pain - not cardiac’ compared to ‘chest pain - cardiac/STEMI’ (24%; 95% CI 14% to 33%). Results were less significant in most fields when adjusted for impression sub categorizations: ‘CP - not cardiac’ vs ‘CP - cardiac/STEMI’. Greater than 97% of all patients received a 12 lead ECG.

Conclusions: Significant disparities were observed between patients experiencing and not experiencing homelessness in the prehospital treatment of CP. Larger scale evaluations are needed to further assess potential disparities in care for people experiencing homelessness in the prehospital setting.