Prehospital triage to improve diagnostic and therapeutic decisions in patients with suspected myocardial infarction

The organisation of cardiac assistance for the general practitioner in the municipality of Rotterdam is well organised, due to an intensive co-operation between the general practitioners, the cardiologists, the Central Doktors Laboratorium (STA.R.) and the ambulance department of the Municipal Heallh Service. The first initiative towards a more intensive cooperation between cardiologists and general practitioners originated by the inititation of the Imminent Myocardial Infarction Rotterdam (IMIR) study, which started in 1972.'·3 The study was initiated and executed by the departments of Cardiology and General Practice of the Erasmus University of Rotterdam. In that study, the significance of prodromal symptoms, identified by means of history taking and physical examination, were studied prospectively in patients who visited their general practitioner wilh symptoms suggestive of myocardial infarction. Detailed history and physical findings were recorded on a standardized questionnaire by the general practitioner. Subsequently, the patient was referred to a special diagnostic centre (the IMIR centre, which was located at the department of Cardiology of the Thoraxcentre of the University Hospital of Rotterdam), where a standard 12-lead ECG was recorded by technicians and blood was drawn for cardiac enzyme determinations (CPK, a-HBDH, SGOT). An additional purpose of the study included the evaluation of this diagnostic centre provided by the study program to the participating general practitioners.

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