EDITORIALS An Integrated Approach to Acute Coronary Care

has rapidly progressed from a dream to a reality, and in the process has engendered staunch ad-vocates'- ' and critics.4 The major basis for the criticism is cost effectiveness, particularly when a specialized uni-purpose vehicle (coronary ambulance) is utilized. The pioneering efforts of Pantridge ' and others2 3 5 6 offered the first encouraging results in reducing the large number of deaths from pre-hospital ventricular fibrillation (VF). Subsequently, a number of so-called coronary ambulances or mobile coronary care units (MCCU) were developed. Such categorical rescue units have not fulfilled early expectations. The number of lives saved has been small, the initial and operational costs high, and the utilization low. These results are not surprising if one considers the fact that most patients with acute myocardial infarction (AMI) wait several or more hours before seeking medical assistance; if cardiac arrest should occur, many minutes often elapse before resuscitation is begun. The answer to the problem of early morbidity in AMI must begin with the development of an in-tegrated emergency program which is not fragmented into organ systems.7 The approach to the acute cardiac patient can be best accomplished through the development of a multipurpose system capable of meeting the myriad of emergency medical needs in the community. Within Los Angeles County a sophisticated system for early coronary care has been developed, largel