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hours of the onset of his symptom will receive emergency coronary angiography and stenting, if clinically indicated. The other reason is the timely delivery of the PPCI Service. While the timing at which the patient presents himself to hospital is less controllable, hospitals can ensure efficient and prompt provision of PPCI by reducing the time taken to effect the treatment, the so-called door-to-balloon (D2B) time. D2B time is an internationally-adopted parameter to track if the care processes within the hospital that provides this emergency service is up to par. This is uniformly low in Singapore.

effective treatment. This treatment is obviously available in the attending ambulance. There are many reasons for this reluctance to call for an ambulance, foremost of which is cultural. Asians may consider it ‘embarrassing’ to activate the ambulance service and to disrupt the peace of the whole neighbourhood. Or patients may be ignorant of the severity of their symptom, or do not know how to activate the emergency service. The ambulance and the attending medical personnel are able to perform emergency resuscitation such as external chest compression, defibrillation, activate the emergency cardiac team at

the nearest hospital, so that the team can be ready even before the arrival of the patient in the Emergency Room.

Adopting Innovative Technology @ NUHCS NUHCS is an early adopter of innovative technology to enhance the care and treatment of her patients with STEMI undergoing PPCI. This includes not just the coronary revascularization procedure performed by the interventional cardiologist but also the resuscitation procedure performed at the A&E and the cardiothoracic surgical support available.

At NUHCS, we performed 434 cases of PPCI in Year 2012, making us the highest volume centre in Singapore for treating patients with STEMI. Ours is a well-oiled system with efficient and timely delivery of care and good clinical outcomes. A total of 9 interventional cardiologists, backed by a well-trained nursing and allied health team, provide round-the-clock emergency PCI service with a median door-to-balloon time of only 60 minutes, which is well within the international recommended time of less than 90 minutes. In fact, NUHCS was instrumental in leading a nation-wide awareness and push to lower D2B time for PPCI and was awarded the National Medical Excellence Award (NMEA) 2011 for its effort.

Push for Early Medical Access One of the keys to survival in a heart attack situation is the access to medical care. Here, it is not just early arrival in hospital, but also the pre-hospital care delivery. In a study conducted at NUH, it was noted that Singaporeans go to hospitals in ambulances in only 35% of cases. The majority of patients make their own way either by public transport or self-drive. One of the potential causes of death during heart attacks is the onset of malignant arrhythmia such as ventricular fibrillation. In such a situation, direct current electric cardioversion is the only mode of

The Straits Times, 1 June 2012. The Straits Times©Singapore Press Holdings Limited. Reproduced with permission.

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Medico Issue 16  
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