When the #NHS is world beating.

Has the Time Come for a National Cardiovascular Emergency Care System? 
Interesting piece from a recent edition of Circulation Journal arguing the case for an organised network to treat cardiovascular emergencies in the USA. A difficult job when one remembers that USA is more of a continent than a country. On this side of the Atlantic, changes are already taking place. The management of ST elevation myocardial infarction in the UK has been transformed in recent years.
 Creation of national networks to manage acute conditions that require a concentration of expertise and materiel is something that the NHS is becoming worldclass at - whether it is for the treatment of myocardial infarction, stroke or soon major trauma. The reasons for this are clear - the NHS is a well funded comprehensive truly national health service in a country where nowhere is too isolated or far away from civilisation! Many around the world must envy this capability.

I am becoming convinced that Ara Darzi was an enlightened genius - A surgeon of course!

Prince Philip and the #NHS

Prince Philip was admitted to Papworth hospital on Xmas Eve having suffered an episode of chest pain. He went on to receive a coronary stent within hours of admission. It is likely therefore that he suffered a ST elevation myocardial infarct (STEMI) or heart attack. It has been suggested in the blogosphere that he received a standard of treatment most plebs would not have received. A STEMI is diagnosed with an on site ECG that is performed by the paramedics.  Until a few years ago, the gold standard of treatment for patients suffering a STEMI was to give an intravenous injection of a clot buster or thrombolysis within 3-4 hours of onset of chest pain. This would dissolve the clot blocking the coronary artery at the site of a narrowing and a full blown potentially fatal heart attack averted. A few years ago, evidence start to emerge that if patients were taken within 3-4 hours straight to the cardiac catheterisation lab, a coronary angiogram performed and the offending blockage in the coronary artery removed mechanically and a coronary stent used to reopen the narrowing, the results were even better than thrombolysis. Getting the cath (catheterisation) lab (not present in all hospitals) and all the staff (who are not resident) ready within 60 minutes of a call several times a night is logistically challenging. I personally thought that it could never happen on a large scale . The above graph from Anglia Strategic Health Authority shows that the percentage of STEMIs or heart attacks treated with Primary Percutaneous Intervention  or PPCI (which is what the procedure is called) has gone from 0% to just under 100% in 2 years These figures are quite extraordinary & have been reproduced around the country (and can be found here). They do represent a triumph for the NATIONAL health service and show that Prince Philip received treatment 90+% would have received.