Sometime in 1967, I came across a report in the BMJ on a paper by Pantridge and Geddes in the Lancet.1 A purpose designed and equipped ambulance that carried a team led by a doctor had been introduced in Belfast for the prompt assessment of suspected myocardial ischaemia. Some months earlier, a patient of mine had died soon after I had visited him at home. I had suspected myocardial ischaemia and, as was the practice at that time, had given him morphine, recommended bed rest, and arranged for a consultant physician to visit as soon as possible that day. Patients with chest pain were admitted to hospital only if they had a confirmed diagnosis of an infarct, and that required the advice of a specialist.
At the next meeting of our local medical association, I floated the idea of persuading the authorities to set up a coronary ambulance service. It could respond rapidly to a general practitioner's suspicion of myocardial ischaemia, assess the patient, take him to hospital if necessary, and defibrillate if that were needed. (It was almost always a him in those days.)
Firstly, we had to persuade the local public hospitals that it was a good idea. Two of the three agreed to participate if we could convince the Department of Health and the Ambulance Service; and that wasn't easy. Eventually we achieved a pilot scheme for our local area. The nearest available ambulance would respond to a general practitioner's call by stopping at whichever of the two hospitals was closest, collecting a medical registrar, a nurse, and their equipment, and taking them to the patient's home.2
From those humble beginnings evolved the now hugely successful intensive care ambulance service. It has specially designed ambulances, covers all of Sydney (population 4 million), and responds promptly with highly trained ambulance paramedics to all medical emergencies.
Twenty years later, when I developed unstable angina, I was collected from my surgery by one of these teams. I was treated with the utmost expertise and efficiency by the paramedics, who delivered me safely to one of the two originally cooperative hospitals, where I had emergency bypass surgery. Thanks to them and the hospital staff, and indirectly to that report in the BMJ, I am here more than a decade later to tell the story.
Footnotes
We welcome articles of up to 600 words on topics such as A memorable patient, A paper that changed my practice, My most unfortunate mistake, or any other piece conveying instruction, pathos, or humour. If possible the article should be supplied on a disk. Permission is needed from the patient or a relative if an identifiable patient is referred to.
References
- 1.Pantridge JF, Geddes JS. A mobile intensive-care unit in the management of myocardial infarction. Lancet. 1967;ii:271–273. doi: 10.1016/s0140-6736(67)90110-9. [DOI] [PubMed] [Google Scholar]
- 2.Alam EJ. Modified coronary ambulances. Med J Aust 1972;Jul 8:110. [PubMed]