Integrated approach to prehospital coronary care in Rotterdam

All ambulances in Rotterdam are equipped with monitoring and resuscitation equipment and staffed with nurses who have the primary role in cardiac emergency care before and during transport to the hospital. Patients are reached in a mean time of 7 minutes. All patients are monitored. Rhythm abnormalities are diagnosed and treated according to standing written orders. Emergency treatment including infusions and intubation can be given. A radio communications center coordinates admission to the nearest available CCU bed. Emergency calls are placed through special telephone numbers for family physicians and previous myocardial infarct patients ("free call"). Patient care by the ambulance nurses is reviewed daily. Ambulance nurses are confronted with a myocardial infarction eight times as often as a family physician--a sound reason to entrust pre-hospital care to them. To extend early treatment into the community, the municipality has subsidized a program to train city workers and volunteers in cardiopulmonary resuscitation. At the end of 1982, approximately 17,000 lay-inhabitants of Rotterdam had been trained. In 1981, 3,557 ambulance trips were made for patients suspected of having acute myocardial infarction. In approximately 40%, this diagnosis was later confirmed from hospital records. Sixty-three patients were admitted to hospital alive, 50 after successful defibrillation. Forty-two patients returned to society after hospitalization. In 24 patients, resuscitation attempts were begun by lay bystanders. Seven of the 24 were admitted to the hospital, and six were discharged alive.