When I qualified as a Doc 30 years there was excellent evidence from the fledgling College of GP's that keeping MI's at home was the best option. When I went for my PRHO interview the Post Grad Tutor was a superb GP, Ron Mulroy. He proved that his MI patients fared better than those rushed into CCU. He showed that by serially monitoring patients moved from home they throw off pre arrest dysrhythmias. Tucking them up in bed at home was the best option. They even used to do home visits in those days. The survival rate was higher in the MI treated at home.
Unfortunately (only joking chaps) thrombolyis arrived to ruin my quality of life and drive me into dispair with increasing unrealistic targets. I'm sure it can't be much joy for the punters being sped through the night with blue lights flashing as some ambulance service or NHS Trust strive to hit targets set by quasi acaedemics sitting on their butts in Euston Tower.
Seriously though if new safe TPA's are out there is there any need to transfer the patient to hospital? Rapid response teams could visit the patients at home and attach the telemetry and send it to the Cardiologists. I could get back to a more normal live and start to enjoy myself for the first time for years and do what I am trained to do which is look after patients as individuals and not "Door to needle times".
Danny McGeehan
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