Intended for healthcare professionals


Should be properly recognised

BMJ 1995; 310 doi: (Published 18 March 1995) Cite this as: BMJ 1995;310:736
  1. C Brittain,
  2. B G Steggles,
  3. C J Eaton,
  4. P J P Holden,
  5. R J Fairhurst
  1. Chairman Vice chairman Honorary secretary Honorary treasurer Immediate past chairman British Association for Immediate Care, Ipswich, Suffolk IP1 2EF

    EDITOR,—The editorial on emergency care in general practice fails to mention the growing trend for many general practitioners not to provide prehospital emergency care for their patients—for example, emergency coronary care or care in asthma.1 Other health care professionals, such as those in the ambulance service and midwives, are only too keen to take on this work to enhance their status. It is surely in the best interests of neither our patients nor the medical profession as a whole for us to lose, by default, what is an integral and rewarding part of general practice. The provision of effective emergency care requires proper contractual recognition, reward, training, equipment, and drugs.

    We are surprised at the authors' suggestion that general practitioners should not waste time obtaining an electrocardiogram in patients with a suspected acute myocardial infarction and at their failure to mention thrombolysis before admission to hospital. The risk of developing a potential lethal cardiac arrhythmia is greatest immediately after the onset of infarction,2 and all patients with a suspected acute myocardial infarction should be monitored electrocardiographically before and during transportation to hospital. It has been shown that the earlier a thrombolytic drug is given the greater the benefit,3 although this is controversial; the British Heart Foundation's latest guidelines recommend that a thrombolytic drug should be given before admission if the likely time from the initial symptoms to thrombolysis being given in hospital is more than 90 minutes.4

    Perhaps the time has come when all aspects of prehospital emergency care, including the mechanisms for the most effective delivery of that care, need re-evaluation.


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