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HSE challenges coroner heart-attack claims

HSE challenges coroner over heart-attack claims

O'Dwyer voices ‘grave concern’ about cardiac care

Neill O’Neill

THE HSE has moved to dismiss a suggestion by the coroner for south Mayo, John O’Dwyer, that people in the county suffering from a coronary event (heart attack) may be as well to ‘bypass’ Mayo General Hospital (MGH) in favour of travelling straight to the cardiac centre of excellence at Galway University Hospital (GUH).
Mr O’Dwyer was speaking after an inquest heard that a 74-year-old man diagnosed with a heart attack at Mayo General Hospital was told he would have to wait close to two hours for an emergency ambulance transfer for urgent treatment in the cardiac centre of excellence in GUH, despite the fact there was a stationary ambulance and crew at their base beside the Sacred Heart Home in Castlebar - less than five minutes away. He died shortly afterwards, despite attempts to resuscitate him.
The ambulance was eventually dispatched after four phone calls between the nursing staff at the hospital and the ambulance base, and a threat by the Clinical Nurse Manager in the accident and emergency department that she would have to ‘document this and report it as an incident’. The ambulance had no other calls to attend at the time and control staff admitted during the inquest that it should have been dispatched.

Not HSE policy
Yesterday (Monday), the HSE issued a statement reiterating ‘if you suspect that you or a family member/friend is having a heart attack you should call the emergency services by dialling 112 or 999 immediately and ask for an ambulance.’
“The Ambulance Service will make an assessment and decide the most appropriate hospital. It is not HSE policy that patients experiencing suspected heart attacks should bypass MGH in favour of travelling directly to GUH. We reiterate that they phone the ambulance services if they suspect that they or a family member/friend is having a heart attack.”
During last week’s inquest, Mr O’Dwyer asked Paudie O’Riordan, Area Operations Manager, National Ambulance Service West, about the reality of getting patients from areas of a rural county like Mayo to GUH in 90 minutes of a heart attack being diagnosed, as the national protocol requests be done.
“My concern is that people get the best treatment,” said Mr O’Dwyer “and the reality is that this is not possible but the people of Mayo are entitled to an equal chance of the best care possible. You have signed up to something not physically possible and now the people of Mayo are not having the same chance of survival. Ninety minutes cannot be achieved, why fool ourselves?”
In the course of this Mr O’Riordan said he accepted ‘and couldn’t deny’ what the coroner was saying, unless the ambulance is parked at the gate waiting to go on what is a 70 minute drive. Mr O’Riordan added that if anybody was to travel directly to GUH, they should call 999 and be met by trained paramedics along the way.

Apology to family
The family of the late Mr Eneas McDonnell then informed Mr O’Riordan that they had received medical advice to attend MGH with their father that evening, to which he responded, “there was an ambulance there that night, I apologise for your situation,”
“Do you acknowledge there was an error made?” he was then asked, to which he replied ‘absolutely’.
In yesterday’s statement, the HSE explains the exact procedures that will be followed by medical staff and paramedics, and moved to clear up any confusion.
“If a person suspects that someone is having a heart attack they should call the emergency services by dialling 112 or 999 immediately and ask for an ambulance.
“When the ambulance arrives the paramedic will perform a test called an ECG or electrocardiogram which measures electrical activity in the heart and is used to identify heart problems,” the statement said. “If a full blown heart attack, known as a ST segment elevation myocardial infarction or (STEMI) is identified, then there are two options.
“The first is that if the ambulance service can get to Galway University Hospitals (GUH) or to one of the other six designated centres in the country within 90 minutes of travel time, then the patient will be brought to the designated centre for a procedure called a percutaneous coronary intervention or PCCI. The ambulance service may also call on the Emergency Aeromedical Service (helicopter) if the flight time including pick-up is within the 90 minute travel time. Alternatively, if the travel time to one of the seven designated centres is more than 90 minutes, the ambulance service will bring the patient to the nearest emergency department for treatment called thrombolysis (clot relief), which will stabilise the patient who can then be transferred to GUH or one of the other designated centres for the PCCI procedure.
“The PCCI procedure is only performed on patients suffering from a STEMI type heart attack. If the ECG test does not indicate a STEMI type heart attack, the ambulance service will bring the patient to the nearest emergency department.”
Mr McDonnell presented at MGH on August 17, 2012, with shoulder pain and shortness of breath, but was not experiencing chest pain, though he informed doctors he had been feeling unwell for an hour beforehand. The pathologist who performed the post-mortem examination after his death stated his belief that the symptoms Mr McDonnell presented with should be considered indicative of a cardiac problem.

Grave Concerns
In closing the inquest, Mr O’Dwyer said that he has ‘grave concerns’ about centres of cardiology excellence, which he said were fine in terms of a patient requiring non-emergency procedures, but where a cardiac arrest is deemed a number one priority in terms of urgency, patients from Mayo still had to make a trip to Galway within 90 minutes of diagnosis, which is ‘unrealistic and unachievable’.
“I will be looking at contacting the Department of Health, the Minister for Health and the Taoiseach,” he said, “as the people of this county are being deprived of the best chance of care and survival of a cardiac incident. With advancements, survival rates of cardiac incidents is improving and people can live on from these. I’m not a doctor but it seems to me there are two choices here, either a cat lab is made available in MGH or a cardiac registrar comes to Castlebar to perform treatments.
“The McDonnell family have lost a husband and father and I hope they feel some comfort that their father did not die in vain. I hope these words are taken on board by those that matter.”
“Instances like this highlight the inequality that we, as a county, have to face.”

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