How we are changing heart attack services
We are changing the way certain types of heart attacks are treated by making a new procedure, called PPCI, more widely available to people in the East Midlands.
We are accrediting some hospitals to specialise in performing PPCI. These hospitals will have the skills, experience and equipment to offer PPCI as an emergency, 24 hours a day. Ambulance crews will be trained to recognise appropriate patients and take them straight to a specialist centre.
In Leicestershire a full service is already operational. All our other counties are currently offering a restricted hours service and are progressing plans for 24-hour provision. Nottinghamshire and Northamptonshire will have realised their plans by this autumn, Derbyshire will have progressed to full service provision by the beginning of 2011, and Lincolnshire in the late summer/early autumn of 2011.
The changes are part of a wider plan for all hospitals. New guidance will make sure everyone with chest pain or a suspected heart attack also gets urgent and high-quality treatment to reduce the amount of damage to their heart.
Under the new system, anyone who has a PPCI should get treatment in a specialist hospital within two hours. People will be taken by ambulance directly to the nearest hospital with a specialist centre that can offer PPCI, rather than the closest hospital. For most people, these will be located no more than 60 minutes away by ambulance.
On arrival, patients will be admitted directly to the catheter laboratory (where PPCI is performed), be assessed by a specialist, have access to tests, and receive PPCI (if appropriate).
The patient will stay in the specialist hospital until they are well enough to be discharged or transferred to a hospital closer to their home where they will continue to receive specialist heart care. Patients will also be referred to a cardiac rehabilitation programme offering support, information and exercise plans. This can improve a person’s chances of recovering from their heart attack and prevent further attacks.
When it is not possible to get to a specialist hospital in time for PPCI, clot-busting drugs can be given by paramedics on the spot, or by staff in the nearest hospital.
Other types of heart attack can be treated safely at local hospitals, as can unstable angina (chest pain). All hospitals will be expected to follow new guidance on how to manage people with urgent heart problems.
Specialist care will mean better emergency treatment and improved rehabilitation. These plans will save lives.
If someone is having a heart attack that can be treated with PPCI, the first two hours are the most important. PPCI saves more lives than the best alternative treatment, as long as it's done within this time. We need to make sure patients reach a specialist hospital and get treated within this time limit.
It takes time to realise someone has had a heart attack and call for help. Once in hospital, doctors need time to do tests and start treatment. We’ve allowed for a 60-minute journey time, and for 30 minutes spent in hospital being examined and having tests. So, our plans should allow us to reach the two-hour goal.
How did we work out journey times?
To calculate journey times, we've taken into account the real experiences of ambulance drivers who make these journeys every day. We’ve looked at records of journeys in rural and urban areas, which give details of how quickly an ambulance can travel down particular roads with its siren on and lights flashing.
The East Midlands Public Health Observatory then took these average speeds and used sophisticated software – as recommended by the Department of Health – to predict how long journeys to individual hospitals would take.
We've used this information to help us plan where specialist hospitals should go, giving everyone the best chance of reaching a specialist heart attack centre within 60 minutes. We've also taken into account different levels of traffic at different times. People should still have a good chance of reaching hospital within 60 minutes even when the roads are busy.
Wouldn't it be quicker to go to A&E?
For some people, it might be quicker to go to their nearest A&E. However, this might not mean the best care. Treating a heart attack with PPCI needs a team of skilled and experienced staff, with access to sophisticated equipment. Specialist teams also need to treat several hundred patients each year to hone their skills and get the best results. Not all hospitals are able to provide this level of care or see enough patients, so it's worth travelling further to a hospital that can.
What if someone just can't get treatment within two hours?
When it's not possible to get to a specialist hospital in time for PPCI, clot-dissolving drugs can be given by paramedics on the spot, or by staff in the nearest hospital. Clot-dissolving drugs (called thrombolytics) are the best alternative treatment if PPCI isn't available.