CAEP Rural Chest Pain Guideline

Country Minutes Matter

Description of the Program:

The Rural Chest Pain Guideline was developed by CAEP to help rural emergency health care facilities achieve these goals:

  • Rapid recognition of chest pain patients with Acute Coronary Ischemic Syndromes.
  • Appropriate management of chest pain patients.
  • Rapid recogntion of patients suffering Acute Myocardial Infarction who would benefit from coronary thrombolysis.
  • Reduce the door to drug time for patients receiving coronary thrombolysis.

The Guideline was developed because rural physicians and nurses noticed that previous efforts to produce a guideline for the emergency management of chest pain patients was not sensitive to the rural context.  Many small details characteristic of delivering emergency health care in a rural setting needed to be considered.  This Guideline was developed by physicians initimately familiar with rural practice.  The Guideline was reviewed by rural nurses, then by nurses and physicians in urban areas who specialize in Emergency Medicine.

The Guideline was developed  by the Rural & Small Urban Committee of the Canadian Association of Emergency Physicians.  Using a systematic literature review, the Committee classified each recommendation by  the best level of evidence from studies in rural settings, and then by studies in any setting.

A peer-reviewed paper describing the methodology, details of the guideline and references was published in the Canadian Journal of Rural Medicine.   The reference for this paper is:

  • Thompson JM, Balfour N, Butt P, Dodd G, Krym V, Loreto C, MacLellan K, Murray J, O’Neill T, Quigg M, Rourke J, Shuster M, Turner P.(CAEP Rural & Small Urban Committee). Chest pain guideline and continuous quality improvement system for rural Canadian emergency health care facilities. Can J Rural Med. 1999:4(1):9-19.

Available in full text on-line at


The Rural Chest Pain Guideline is approved by the following Canadian organizations:

caeplogo1 Canadian Association of Emergency Physicians

srpcSociety of Rural Physicians of Canada

amuq L’association des médecins d’urgence du Québec

nena National Emergency Nurses Affiliation

Unrestricted funding for this project was provided by:

Hoffmann La-Roche Ltd. roche

The wall poster images were produced by Remtulla + Associates in Toronto, Canada, funded by Hoffmann La-Roche.
The CMM software was produced by Biocom in Toronto, Canada, funded by Hoffmann La-Roche.

Wall Posters:

Key features of the Rural Chest Pain Guideline are summarized in a wall poster in both French and English.   The poster summarizes major points in the initial management of patients with chest pain by the public, prehospital ambulance systems, hospital receptionists, Emergency Nurses and Emergency Physicians.  Each phase is associated with practice objectives.  The data points used in the Country Minutes Matter CQI software are also shown.  Refer to the paper cited above for detailed guidelines and the rationale for each step.

JPEG Versions: Click on the small images below to view larger versions.



Acrobat Versions: You can download colour PDF versions of these posters which you can view and print with Adobe Acrobat Reader.

Country Minutes Matter CQI Software:


Hoffmann La-Roche Ltd developed a Windows program called Country Minutes Matter based on the CAEP Rural Chest Pain Guideline. CMM can be used by rural hospitals to develop a personalized Continuous Quality Assurance program for managing chest pain patients.
The software was designed to be as easy to use as possible for rural hospital staff. The program requires up to 20 data points, depending on whether the chest pain patiient had an MI or not, and was transferred or not:

  1. Patient’s Name
  2. Date of service
  3. Patient’s Age
  4. Time symptoms began
  5. Time of arrival
  6. Time of initial assessment by triage Registered Nurse.
  7. Time of first ECG
  8. Time on-call physician notified
  9. Time on-call physician arrived
  10. Acute Myocardial Infarction diagnosed? YES NO
(If “yes” then complete 11-16; if “no” then skip to 17).
  11. Thrombolytic therapy ordered? YES NO
(If “yes” then skip to 13).
  12. Reasons thrombolysis not ordered (go to 17).
  13. Time of first diagnostic ECG
  14. Time thrombolytic therapy ordered
  15. Time thrombolytic therapy started
  16. Thrombolytic agent used.
  17. Was patient transferred to another facility? YES NO
(if “no” then skip to 19).
  18. Date and time transferred
  19. Reasons for transfer.
  20. Delays Identified, if any:
Prehospital Phase, Waiting Room Phase, Nursing Phase, Physician Phase.

These are the data points  recommended in the CAEP Rural Chest Pain Guideline. They are felt to be the minimum data that should be collected in a CQI program intended to help rural hospitals maintain high quality care of chest pain patients.

cmmentryTo view a larger (34 kb) image of this CMM data entry screen, Click Here.

We hope to provide a copy of the CMM program at this website for downloading in the near future.
For further information regarding the Rural Chest Pain Guideline, contact: – Chair, CAEP Rural & Small-Urban Committee or the Ottawa, Canada / 1-800-463-1158.