HART-c: Prehospital triage via hospital consultation—the future lies in the ambulance

Abstract

The future of improved care in treating the right patient at the right place lies in the ambulance. In recent years, more and more initiatives have been developed showing that, besides general practitioners, ambulance personnel have a prominent role in prehospital triage and referral decision-making. They are highly trained, work strictly according to a national protocol and often participate in complex randomised controlled trials.This situation in the Netherlands is unique in the world; only a few countries have comparable emergency medical systems [1,2]. Many innovations in the prehospital care of acute cardiac patients were co-initiated in the Netherlands. For example, the prehospital diagnosis of acute ST-elevation myocardial infarction (STEMI), which paved the way to the prehospital treatment with thrombolysis and later to immediate referral and transfer to the nearest intervention centre to perform primary percutaneous coronary intervention (PCI). Since early this century, patients without ST elevation on the diagnostic ECG are also part of scientific studies aiming to improve logistics, triage and treatment of patients with (suspected) acute myocardial infarction or other acute cardiac pathology.De Koning et al. describe the results of the HART-c project, another example of such a new develop-A. W. J. van 't Hof ( )