Mobile Coronary Care

In a seven–month period, a mobile coronary care unit (MCCU) attended 175 calls. Although the average time for the MCCU to reach patients was only 19 minutes, 12 patients with probable myocardial infarction were dead when the ambulance arrived. Ninety-seven patients with proven myocardial infarction were transported to hospital; although 40 of these patients required treatment for a cardiac arrhythmia in the MCCU, there were no deaths in transit. Three patients were successfully resuscitated from ventricular fibrillation in the MCCU, but subsequently died in hospital as a result of the severity of their infarction. The main function of a MCCU, however, is not the resuscitation of patients with cardiac arrest, but rather the taking of effective treatment for cardiac arrhythmias to the patient at the earliest possible time. The major component of delay in the hospitalization of patients with myocardial infarction was the patient's own delay in seeking medical aid. Patients waited an average of 2 hours 42 minutes before calling their doctor, although 50% of patients delayed less than one hour. Practitioners responded promptly, arriving at the patient in a median time of 15 minutes and calling the MCCU in a median diagnostic time of 15 minutes. Despite the brief diagnostic time, acute myocardial infarction was present in 55% of cases, and only four of 175 calls were considered unjustified. In only a small proportion of cases, however, did the practitioner remain with the patient until the MCCU arrived. The MCCU facilitates the interhospital transport of patients with emergency medical conditions other than myocardial infarction, for example severe cardiac arrhythmias and massive pulmonary embolism.