In the United Kingdom, it is unlikely that angioplasty would be the first-choice treatment for a patient with signs of acute myocardial infraction. In my region of more than 2 million people, fewer than 5 of the 17 hospitals allowing acute nontriaged medical admissions have the facilities for rescue angioplasty. If it were thought that this was the appropriate treatment, the patient would have to be transferred at that stage to one of those hospitals. Very few patients are transferred from intensive care unit (ICU) to ICU by helicopter, in my area, only one helicopter is operated by the regional ambulance service, and this helicopter is more suited to primary retrieval than secondary transfer. Few hospitals have helipads. It is less time-consuming to transfer a patient by road than by helicopter if no helipads are available, because the latter type of transfer involves exporting the patient from the unit on a trolley, transferring him or her to an ambulance for the trip to the local park or open space, transferring the patient to the helicopter, flying to another park or open space, transferring the patient into another ambulance, and transferring him her into the hospital. A marginally more suitable helicopter (bigger, but with no medical facilities) is offered by the military. However, it is not always available, and the hospital is charged for its use. The transfer team members may not be returned to their base if the helicopter is called elsewhere.
KeywordsTreatment Withdrawal Local Park Continuous Venovenous Hemofiltration Secondary Transfer Interhospital Transfer
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