I agree with Anton that the Cath lab business is one we need to debate.
However, I'd guess you'd be getting about a patient a week per 100k
population, mainly out of hours. I'd be surprised if your cardiologists
would want to come in more than about once a fortnight each for this (it
being a rapid response from home). Means you need a couple of cardiologists
per 100k population. Use of SpRs unsupervised won't be a long term option.
BTW, Anton, on mobile cath suites- I seem to recall seeing an advert from a
company that provides portable operating theatres, cath suites etc. on a
rental basis.
However, I think the whole thing about timing is reading too much into a few
poor quality (from the view point of the timing) studies- the initial
studies were RCTs with regard to use of thrombolysis but observational
studies with regard to timing. It is an extrapolation to assume from these
that improving your times will improve outcomes.
I know I keep harping on about it, but seeing as how it's the study that
keeps getting cited to support the resources that are transferred from where
they are needed into pre-hospital thrombolysis: The GREAT study showed
improved times with prehospital thrombolysis. However, analysed on an
intention to treat basis (as should always be done- otherwise selection bias
makes the study meaningless), the prehospital group had an increased
mortality.
Matt Dunn
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