Editorial Twenty years of prehospital coronary care

By 1965 the possibility of preventing deaths from arrhythmia among those stricken with coronary attacks was already well established. The realisation that most of these deaths occur shortly after onset and therefore outside hospital led to the recognition that hospital coronary care units were of limited value because most patients who reached them were already either convalescent or moribund. Professor JF Pantridge (then Dr) and I therefore decided to arrange that trained staff with equipment should reach the coronary victim as soon as possible after the onset of the attack. A mobile coronary care unit was introduced in Belfast on 1 January 1966.' At that time the components had to be assembled to make a defibrillation system available. We soon demonstrated that resuscitation from ventricular fibrillation could be achieved in the prehospital setting.23 The system was successful in reaching the majority of patients early and this reduced the disparity in place and time between the need for coronary care facilities and their availability. Furthermore, deaths during transport to hospital were virtually eliminated among patients receiving prehospital care. During the subsequent years prehospital coronary care systems were established in many parts of the world.4 Some of these units were staffed by physicians but, particularly in the United States, the tendency grew for staffing to be provided by paramedical workers, technicians, or a tiered combination of both. In Britain a unit staffed by specially trained ambulancemen was set up in Brighton in 1971.5 Against the background of these developments it is useful, after two decades, to survey the achievements of prehospital systems and to consider why the principle has been accepted with enthusiasm in some countries and not in others. As experience of the acute phase of infarction in