Every second heart attack patient in India takes more than 400 minutes to reach a hospital, which is almost 13 times more than the ideal window of 30 minutes, government data shows.
A two-year data from the ongoing Management of Acute Coronary Event (MACE) Registry of the Indian Council of Medical Research (ICMR) shows at some places it even takes 900 minutes as a lot of time is wasted in transportation.
“A lot of precious time is still being wasted in taking a heart attack patient to a facility that is capable of treating heart attacks. The delay mostly is because of the patient being remotely located in rural areas or belonging to a terrain that is difficult to access,” said Dr Meenakshi Sharma, a scientist at ICMR.
Beyond 180 minutes, the heart muscles suffer irreversible damage due to lack of blood supply.
“If the clot buster medicine is not given within three hours, the chances of patient pulling through are near zero. Ideally, it shouldn’t take more than 30 minutes from symptoms to the door of a hospital equipped to treat heart attack cases,” says Dr Thomas Alexander, Kovai Medical Center and Hospital, Coimbatore.
- For Critical Cardio Pulmonary Resuscitation (CPR), a few important concepts should be kept in mind
- Start compression within 10 seconds of recognising a cardiac arrest
- Push hard and push fast: at a rate of at least 100 compressions per minute with a depth of at least 2 inches (or 5cm) for adults
- Allow complete chest recoil after each compression
- Minimise interruptions (try to limit interruptions in compressions to less than 10 seconds)
- Give effective breathing that makes the chest rise
- Avoid excessive ventilation
- Never learn CPR on live people
- During CPR if the ribs break, do not worry
- After successful CPR, take the victim to the nearest hospital
- CPR should always be done on the floor or a hard bed
- Alternate cardiac massage on the chest after every two minutes
Dr Alexander, along with Dr Ajit S Mullasari from the Madras Medical Mission Hospital, Chennai, as part of STEMI India, developed a unique model of heart attack care that reduced deaths by 20%.
The ICMR-funded project implemented heart attack management protocol on a trial basis for a year in Tamil Nadu. The results are published in the latest issue of the Journal of American Medical Association (JAMA Cardiology). “We tied up with the state government for the project as it required the utilisation of BPL insurance to pay for treatment, government emergency ambulance service that is equipped with advanced gadgets to screen patients, and transfer data and its hospitals to treat,” said Dr Mullasari.
There were four main hubs and 35 spoke hospitals in the cities, suburbs and rural areas that were interconnected.
“Smaller hospitals may not be able to provide specialised treatment but they can always administer life-saving interventions under the supervision of experts in a tertiary care facility before referring them,” said Dr Mullasari. ICMR has invited other states to take up the programme, and most have shown interest. While Tamil Nadu is scaling it up, Telangana, Meghalaya and Karnataka will be starting the programme soon.