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Week 6 Case Study

Chest Pain & Chronic Risk

The Scenario

It is 11:30 on a Monday morning when Paramedics Kate and Reece are dispatched to a construction site office in Toowoomba for a 52-year-old male, Gary, complaining of central chest pain radiating to his left jaw. The site foreman called 000 after Gary became pale and diaphoretic while climbing a flight of stairs to the lunch room. Gary initially resisted calling an ambulance, saying "It's probably just indigestion. I had a big brekkie."

On assessment, Kate finds: BP 162/98, HR 102, RR 22, SpO2 96%, GCS 15. A 12-lead ECG shows ST elevation in leads II, III, and aVF, consistent with an acute inferior STEMI (ST-elevation myocardial infarction). Gary rates his pain 8/10 and describes it as a "heavy pressure." Kate initiates the QAS STEMI clinical pathway: aspirin 300 mg, GTN spray, morphine for pain, and activates the cardiac catheterisation lab at Toowoomba Hospital for direct transfer.

During transport, Kate takes a more detailed history. Gary smokes 20–25 cigarettes per day and has done so since age 16 (a 36 pack-year history). He is visibly overweight—he estimates his weight at around 115 kg at 178 cm tall (BMI ~36, obese class II). He was diagnosed with type 2 diabetes four years ago but admits he "doesn't really watch what I eat" and hasn't checked his BGL in months. His last HbA1c was 9.2% (poorly controlled). He reports doing no regular physical activity outside of incidental movement at work, and his diet consists largely of takeaway food, energy drinks, and meat pies from the servo. His father died of a heart attack at age 58, and his older brother had a coronary artery bypass graft at 55. Gary tells Kate, "I know I should have done something about all this. But you don't think it'll actually happen to you, you know?"

Discussion Questions

1 List the "big four" non-communicable diseases (NCDs) as defined by the WHO. Which of these is Gary currently experiencing, and what other NCDs from the "big four" is he at risk of developing based on his risk factor profile?
2 Identify all of Gary's modifiable risk factors and non-modifiable risk factors for cardiovascular disease. For each modifiable risk factor, suggest an evidence-based intervention that could reduce his future risk (e.g., smoking cessation programs, dietary counselling).
3 Explain the concept of DALYs (Disability-Adjusted Life Years). If Gary survives this STEMI but has reduced cardiac function requiring ongoing treatment and activity limitation, how would his condition contribute to Australia's burden of disease as measured by DALYs? Distinguish between YLL (Years of Life Lost) and YLD (Years Lived with Disability).
4 Gary says, "You don't think it'll actually happen to you." Discuss this statement in relation to risk perception and the Health Belief Model. What factors influence a person's perceived susceptibility to disease? Why do people often fail to act on known risk factors despite understanding the evidence?
5 Cardiovascular disease is the leading cause of death in Australia but is largely preventable. Discuss the burden of disease caused by NCDs in Australia using current AIHW data. What proportion of Australia's total disease burden is attributable to the "big four" NCDs?
6 As a paramedic, Kate's immediate role is acute cardiac care. But considering a public health lens, what opportunities exist for paramedics to contribute to NCD prevention and risk factor reduction in the community? Should paramedics provide brief interventions (e.g., smoking cessation advice) during patient contact? What are the arguments for and against?

Key Concepts Applied

The "Big Four" NCDs

Cardiovascular disease, cancer, chronic respiratory disease, and diabetes—responsible for over 70% of global deaths. Gary has two of the four.

Modifiable Risk Factors

Smoking, poor diet, physical inactivity, and harmful alcohol use are the four behavioural risk factors that drive most NCD burden. Gary exhibits three of these.

DALYs

Disability-Adjusted Life Years combine premature death (YLL) and years lived with disability (YLD) to measure the total burden of disease on a population.

Burden of Disease

NCDs dominate Australia's disease burden. Coronary heart disease is the single largest contributor, with much of it attributable to preventable risk factors.

Risk Perception

People systematically underestimate their personal disease risk despite knowing the evidence. Optimism bias and present bias delay preventive action.

Brief Interventions

Short, opportunistic counselling by healthcare providers (including paramedics) can shift patient behaviour, particularly for smoking cessation and alcohol reduction.

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