A Mobile Coronary Care Unit- An Evaluation for Its Need

Although the few existing mobile coronary care units have proved effective, the establishment of a new unit is expensive. In order to determine the usefulness of such a unit an evaluation of present patterns for care of the acute myocardial infarct patients and patients dead on arrival at a west-side Cleveland hospital was made. The greatest delay in the care of the acute myocardial infarct patient was his own unwillingness to call for help. The median time for transport of patients to the hospital was 25 min. The study of patients dead on arrival at the hospital showed that the time needed for rescue squads to reach the patients was too long in almost all cases for effective resuscitation to be accomplished. This study shows that present transportation facilities for the acute myocardial infarct patients in this community are adequate. Added equipment and training of personnel for the existing units could obviate the need for a centrally based and more costly mobile coronary care unit. ALTHOUGH CORONARY care units have reduced by one half the hospital mortality rate for patients with myocardial infarct, they can do nothing for approxi-mately 250,000 Americans who will die from heart attacks this year before they arrive in the emergency room. The prevalence of sudden deaths due to fatal arrhythmia is highest in the first few hours after myocardial infarct (1). Sixty percent of the deaths from myocardial infarct occur within 1 hr of onset and 85%, within 24 hr (2). If such patients could come under intensive medical care sooner, the stag-gering mortality rate due to coronary heart disease might be reduced significantly. A mobile intensive care unit has been in operation since January 1966, as described by Pantridge and Adgey (3) and by Ker-nohan and McGucken (4) and Grace (5) in 1968. Mobile coronary units are being plannfcd in nu-merous areas throughout this country. This paper evaluates the need for and possible effectiveness of a mobile coronary unit before its operation. Since there are striking environmental differences among various cities and since the cost of a mobile coronary unit is great, both in dollars and skilled personnel, such evaluation is thought desirable (6)