Establishing a mobile coronary care service in a rural setting.

A mobile coronary care unit (MCCU) service was introduced at Sligo General Hospital in 1992. Initially, a medical registrar and CCU staff nurse drove a fully equipped MCCU car to the patient location (Phase 1). When the patient was medically stabilised and had received thrombolysis, if appropriate, the doctor and nurse travelled with him in the conventional ambulance to the hospital. Subsequently, on a pilot basis, the doctor, nurse and equipment were transported by taxi to the patient (Phase 2). Since 1995, the MCCU service has been provided routinely by Sligo General Hospital (Phase 3). During each Phase the proportion of patients with acute myocardial infarction (AMI) was as follows: Phase 1--16 of 35 (46%), Phase 2--7 of 19 (36%), Phase 3--53 of 154 (34%). The incidence of unstable angina (UA) was 25%, 32% and 26% during each of the three Phases. Five patients had successful out of hospital (OOH) defibrillation and 56(74%) of the 76 AMI patients had OOH thrombolysis. The MCCU reduced the median "Call to needle" time by 64 minutes in Phase 1 and 102 minutes in Phase 2 compared to the conventional service. Median delay to MCCU treatment was 46, 40 and 80 minutes during each of the three Phases. In an Irish setting, a MCCU service provided rapid safe and effective care, including thrombolysis and defibrillation for patients with suspected AMI.