Cardiac care in SAR helicopter paramedic practice: from mountainside to rehabilitation

Abstract

Despite its decline in recent years, coronary heart disease remains the UKs single biggest killer. When someone suffers a heart attack on a mountainside in the UK, they often need a search and rescue (SAR) helicopter to provide them with timely emergency care and to transport them to a suitable hospital. The early diagnosis of an ST-elevation myocardial infarction (STEMI) from a 12-lead electrocardiogram facilitates timely initiation of reperfusion therapy, but obtaining one in the mountain rescue environment is challenging and sometimes impossible. Although primary percutaneous coronary intervention for STEMI patients is the treatment of choice, facilitating it renders the SAR aircraft unavailable for greater periods of time and requires the relevant, supporting infrastructure to be in place. The SAR paramedic must assess the suitability, validity and usability of clinical guidelines and pathways on a case-by-case basis, then integrate them into the demands of each particular SAR mission. Although cardiac rehabilitation has not traditionally been within the remit of the pre-hospital clinician, responding to the psychological needs of the heart-attack victim in the aircraft may be a significant determinant to their participation in rehabilitation programmes.