Mobile coronary care the coronary ambulance

Abstract

The organization of the Barnsley Coronary Ambulance Service covering a population of 200,000 is described and an analysis is made of thefirst 500 calls over a period of I4 months. A diagnosis of definite (6o%), probable (7%), and possible (7%) acute myocardial infarction, based on World Health Organization criteria, was made in 370 patients (74%). The various delay factors from the time of onset of the patient's symptoms up to admission to the hospital coronary care unit are described. Seventy-five per cent of the patients were reached by the ambulance in less than I2 minutes after sendingfor the ambulance, and 95 per cent in less than 22 minutes. One hundred and eighty-five out of the 370 patients (y5o%) had a total of 24I individual episodes of cardiac arrhythmia at some time before hospital admission. Cardiac arrest occurred in i6 patients of whom there were only 3 long-term survivors dischargedfrom hospital, all with ventricularfibrillation. The overall mortality in the 370 patients with myocardial infarction was I8 per cent. An attempt is made to assess objectively the value of the coronary ambulance, and the cost effectiveness is also discussed. It is suggested that the service is both of medical benefit to the patients and of long-term financial benefit to the Government.