[Integration of the hospital coronary care unit with the first aid service for the domiciliary treatment of cardiovascular emergencies]. / Integrazione dell'unità coronarica ospedaliera con la guardia medica per il trattamento domiciliare delle urgenze cardiovascolari.

ABSTRACT

To evaluate the feasibility and the utility of an integrated service for the pre-hospital diagnosis and care of cardiovascular emergencies a new pre-hospital intensive care system has been developed. Such an emergency medical service relies on the telephone transmission of ECG and the conversation between the first aid service and the cardiologist of the hospital coronary care unit. It also implies early therapeutic intervention performed at home under the responsibility of the chief physician of the referring centre. From March '86 to December '88, 311 telephone ECG transmissions were obtained; the home diagnosis and the consequent proper therapeutic regimen were considered sufficient to avoid the transportation of the patient to the hospital emergency room in 43% of the cases. The symptoms were precordial chest pain (54%); palpitations (10%); dyspnea (8.4%); hypertensive crisis (1.3%), dizziness or syncope (12.3%). Pre-surgical or organ transplantation controls totaled 13.5%. One-hundred-forty-eight patients were admitted to the coronary unit because of an acute myocardial infarction between June and December 1988. Forty-seven patients were sent by the family doctor (group I) and 30 patients by the first aid service (group II) without any electrocardiographic diagnosis or home therapy; 14 patients were sent by the first aid service after a telephone transmission of ECG and early therapeutic intervention (group III); 57 patients reached the hospital independently (group IV). The following differences among the groups were observed only the patients of group III received proper early therapeutic regimen at home, and 85% were admitted within 4 hours of the onset of symptoms (vs 46% of the patients of the other groups).(ABSTRACT TRUNCATED AT 250 WORDS)