The mobile coronary care unit and the decision to seek medical care during acute episodes of coronary artery disease.

The mobile coronary care unit (MCCU) as a means of reducing coronary artery disease (CAD) morbidity and mortality cannot be realized unless patients, lay others, and medical personnel use it. The initial medical care decision of 1,102 patients who experienced acute cardiac symptomatology was studied to determine factors contributing to expedient care-seeking and the decision to use emergency medical services (EMS), direct emergency room services, or physician consultation. An expedient decision to utilize the EMS, the only means of obtaining the MCCU, occurred when symptoms began suddenly and were incapacitating, lay others advised the EMS, and patients relinquished and lay others usurped control of care-seeking process. To increase MCCU utilization and effectiveness, it is suggested that public education about CAD be refined and the teaching of cardiopulmonary resuscitation expanded, physicians be encouraged to educate patients realistically as to CAD prognosis, and a cardiac crisis center be instituted that incorporates a registery for patients at high risk of myocardial infarction or sudden cardiac death.