PROBLEMS OF PRE-HOSPITAL PHASE OF ACUTE MYOCARDIAL INFARCTION

The pre-hospital phase of acute myocardial infarction poses the greatest single medical problem of our nation in terms of loss of potentially salvageable life. Some advances in management are possible and have been demonstrated based on the current fund of knowledge. These advances consist of various means of foreshortening the pre-hospital or predefinitive care phase to allow the earlier application of established technics of arrhythmia control. It seems likely that perfection of the present extended systems of coronary care will leave a substantial residual mortality-of about 30 per cent of all deaths in the first six hours-consisting of patients who die so suddenly that no triage or retrieval system can realistically be expected to help and those in whom treatment fails. The most promising approach to this group seems to be through further investigation with the purpose of earlier identification or prediction of the episode and improved prophylaxis and therapy. © 1969.