Prehospital Care of Acute Myocardial Infarction

Abstract

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.

Pathophysiologic Observations in Prehospital Ventricular Fibrillation and Sudden Cardiac Death

“…Although much attention has been given to the problem of prehospital SCD,'"-' [49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67] several important areas remain poorly defined. These include: (1) conjectural, and information concerning rhythms which precede those monitored by rescue workers is not available.…”

Retrospective analysis of the role and performance of family medicine versus emergency medical services in the pre-hospital management of patients with AMI in Banja Luka

“…This could possibly explain why the majority of patients established their first medical contact in an EMS, as well as the shorter delay in seeking medical help and the greater accuracy in the diagnosis. However, the time frame for seeking medical help might also be related to a lack of information, not only to the severity of symptoms, concerning the significance of the pain, denial that the chest pain may actually signal a heart attack, misinterpretation of the chest pain, reluctance to call the family practitioners at an inconvenient time and lack of encouragement from family members for seeking medical help (19)(20)(21)(22). The definitive and referral diagnosis from the FMS coincided to a lesser degree with the diagnosis made in the EMS.…”

Sudden Death and The Pre-Hospital Phase of Acute Myocardial Infarction

“…The concept of life-support stations has been supported by several workers, and all have recognized the need for training paramedical personnel in the emer gency care of coronary events and the necessity for having a system capable of monitoring and stabilizing cardiac rhythm at the earliest possible moment. Lown & Ruberman (20) and Yu (21,22) have suggested pre-coronary areas in emergency rooms, which would provide ambulatory triage and encourage self-referral. Such fixed life-support stations in emergency rooms of hospitals would be appropriate for both large and small communities and hospitals throughout the country, whereas mobile life-support units may be feasible and suitable in a limited number of large cities.…”