DIRECT ADMISSION TO THE CORONARY-CARE UNIT BY THE AMBULANCE SERVICE FOR PATIENTS WITH SUSPECTED MYOCARDIAL-INFARCTION

Background-Direct access to the coronary care unit (CCU) for general p ractitioner (GP) referred cases of suspected acute myocardial infarcti on (AMI) (fast track admission) substantially reduces the time to thro mbolysis. Until now, this policy has been confined to GP referrals. Ob jectives-To determine the time taken to admission to CCU under the fas t track policy (ambulance referrals and GP referrals) and the time tak en to start administration of thrombolytics (ambulance referrals, GP r eferrals, and accident and emergency referrals). Methods-Fast track ad mission policy was extended to include referrals from ambulance person nel who respond to emergency service calls. Ambulance personnel referr ed cases were also examined to see if they were referred appropriately to the CCU. Results-100 ambulance personnel referrals and 260 GP refe rrals to CCU with chest pain were studied. Forty accident and emergenc y referrals who had AMI requiring thrombolysis were also studied. In t he ambulance referred group the time to admission fi om phone call was a median of 10 minutes (range 2 to 45), a saving of 30 minutes compar ed with GP referrals (median 40 minutes, range 2 to 217). The median d iagnostic electrocardiogram (EGG) to thrombolysis time was longer in t he accident and emergency referrals with AMI than either ambulance ref errals or GP referrals admitted under the fast track policy. Diagnosti c ECG to thrombolysis time: accident and emergency 50 minutes (range 1 5 to 385); ambulance referrals median 33 minutes (range 6 to 69); GP r eferrals median 29.5 minutes (range 5 to 110 minutes); (p = 0.056 acci dent and emergency compared with ambulance referrals, p < 0.002 accide nt and emergency compared with GP referrals). Of 100 ambulance referra ls 52 patients exhibited symptoms suggestive of ischaemic heart diseas e (confirmed AMI, unstable angina, and angina) and a further 18 patien ts were required to stay in CCU for other cardiac problems. Thus a tot al of 70 (70%) were considered appropriate compared with 155 of 260 (5 5.8%) GP referred cases. Conclusions-Extending the fast track admissio n policy to ambulance personnel reduces delay to admission for patient s with suspected MI without adversely affecting the appropriateness of admissions.