It has been estimated recently that half of deaths among the patients with acute myocardial infarction occur before they ever reach the hospital for definitive medical care. One of the major reasons for the high incidence of death was attributed to delays in reaching medical care, involving patients themselves, physicians, transportation, and receiving areas of the hospital. In order to reduce this high mortality substantially we should focus our attention on the prehospital care of this disease, which may include several major approaches.
A. To shorten the delay in securing medical care:
1. Public education, with emphasis on the early warning symptoms and signs of acute myocardial infarction, and the need and importance of seeking early medical care, with special attention directed toward the high-risk coronary patients.
2. Professional education.
3. Mechanisms to direct and/or bring patients with suspected or proven acute myocardial infarction promptly to the system of medical care with special emphasis on the utilization of a telephone information center and provision of rapid transportation.
B. Establishment of emergency life-support stations for screening, monitoring, and early stabilization of cardiac arrhythmias:
1. Fixed.
a. Emergency department of hospitals, preferably with an attached precoronary care area.
b. Areas where many employees are working on weekdays.
c. Areas where many people move in and out from day to day.
d. Areas where there is periodic concentration of mass population.
2. Mobile.
a. Mobile coronary care unit.
b. Mobile intensive care unit.
C. Prevention of sudden death:
1. Study of mechanism and clinical environment of sudden death.
2. Development of techniques for early diagnosis and management of acute myocardial infarction prior to inception of symptoms.
3. Identification of individuals prone to sudden death.
4. Preventive measures directed toward the individuals prone to sudden death.
a. Effective control of risk factors.
b. Intermittent or periodic electrocardiographic monitoring in these individuals.
c. Long-term antiarrhythmic therapy for these individuals.
d. Possibility of implanting an automatic defibrillator in patients with previous myocardial infarction or in those recovered from ventricular fibrillation.
5. Early administration of antiarrhythmic drugs in patients with suspected or proven acute myocardial infarction.
