Roscommon Hospital. Key questions for the people?

The report below appeared in the Indo.
I will write more on the issues on primary angioplasty (Sticking a catheter into the coronary arteries to blow open blockages using a balloon) later. But it is proven for some time that this is the best treatment for classical coronaries.

The question is one of resources and manpower deployment.

How many hospitals in the republic have 24/7 access to primary coronary angioplasty? Name them.

How many have daytime access to coronary angioplasty?

How many coronary angio suites are there in the country?

How many invasive cardiologists are there in the republic? How many cardiac electrophysiologists there in the republic?

(Smaller hospitals should have a facility for transfer of ECGs to a consultant cardiologist for advice 24/7. This is where the future lies. The NHS direct nurse-lead service is one template but the real one is the use of Bangalore in India by clinics in Western US to report CT scans through the night.)

How many are there in public hospitals?

How many areas are covered by advanced paramedics?

Why does Roscommon Hospital not administer thrombolysis to diagnosed coronaries?

What is the norm across the western world country by country?

Could we have the audited data for myocardial infarction (heart attack) area by area across the country with a statistical analysis to ensure a valid comparison like with like?

There is an implication that NCHDs are not competent to deal with most clinical situations. That is simply untrue. The culture of phoning senior consultants for advise and opinion has diminished. NCHDs should to encouraged to do so and not be made feel inadequate for so doing. You can ring me on biochemical or toxicology matters anytime from anywhere around the country on my usual number. 087-2544646 Text me in preference and I will call you back. That is 24/7 by the way and I am not joking.

PS – I know that the Connolly Hospital primary angioplasty link with the Mater works like clockwork and the audit results confirm this.

Cardiac patients ‘better off in big hospital’

By Eilish O’Regan Health Correspondent
Saturday July 09 2011
Heart attack patients in Roscommon should ideally have treatment in University College Hospital in Galway within 90 minutes to optimise the chances of survival, a cardiologist said yesterday.
The Galway hospital is the only facility in the west that can perform angioplasty, which can treat the acute blockage in one of the patient’s arteries.
The alternative is that the patient is given clot-busting drugs at the scene by an advanced paramedic while being transported to hospital, said Dr John Barton, a cardiologist at Portiuncula Hospital in Galway.
These clot-busting drugs can only be given by an advanced paramedic or can be administered in hospitals in Sligo, Portiuncula, or Mayo General Hospital. But they cannot be administered at Roscommon hospital.
They can send an ECG from their ambulance to the hospital and doctors can direct them to give the clot-busting medicine. It only works in 60pc of cases .
The earlier a patient receives the drug the better, unless they can make it to a major hospital where they can have the angioplasty. The maximum time allowed for an artery to be opened in hospital from the first call is two hours, he added.
The HSE has said it is increasing the number of advanced paramedics working in Roscommon from next week. Dr Patrick Plunkett, consultant in emergency medicine at St James’s Hospital in Dublin, said heart attack patients stood a much better chance if they got to a hospital to have the arteries opened than if they received the clot-busting drugs.
“You can only do that in a major emergency centre,” he added
Asked what the advice for stroke victims was, he said the ideal was to have the patient given clot-busting drugs in a major hospital within four-and-a-half hours. If it is given within three hours, one-in-nine patients will make a significant recovery.
Referring to road accident victims, he said it was increasingly the case that fewer surgeries were being performed immediately after an accident because of improvements in CT scanning, which allows doctors to hold off on operations until later.
He said he believed people stood a better chance overall even if they had to travel a longer distance to the major emergency department.
– Eilish O’Regan Health Correspondent