New delay fear for heart patients

HEART attack victims facing dashes for life may be given no pain medication for up to 20 minutes because not all ambulances have paramedics on board, it emerged today.

HEART attack victims facing dashes for life may be given no pain medication for up to 20 minutes because not all ambulances have paramedics on board, it emerged today.

This shocking new concern, which emerged the day before heart tsar Professor Roger Boyle is due to visit Ipswich, is just one of many expressed by doctors at Ipswich Hospital who are worried they will be failing patients by forcing them to travel to far-flung specialist centres for emergency heart attack care.

In sensitive e-mails seen by The Evening Star the hospital's director of Accident & Emergency, Dr David Hodgkinson, and consultant cardiologist, Dr Duncan McNab, highlight numerous serious anxieties to health bosses at the East of England Specialised Commissioning Group (SCG) and Strategic Health Authority (SHA).

These include worries over pain relief because some ambulances have technicians onboard instead of paramedics. The technicians are not as highly trained and can not administer intravenous drugs.

Meanwhile the e-mails also reveal:

That doctors are worried about their ability to deliver the proposed service and are unconvinced it is the best option for Ipswich patients

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That there is doubt over the quality of evidence surrounding primary angioplasty centres

That patients living in Suffolk may be almost twice as likely to die as those living near specialist centres

The e-mails, released by the SHA under the Freedom of Information Act, show there is debate about the best options for patients in Ipswich and Suffolk, despite SHA claims to have clinical support for the move.

Ben Gummer, Conservative parliamentary candidate for Ipswich, who has been campaigning for a specialist heart attack centre to be set up in Ipswich, said: “The release of these e-mails show that the SHA has been deceiving people in the way it has described its proposed changes.

“For one it didn't have the backing of doctors in the way that the SHA tried to lead us to believe.

“It is also clear that the particular arrangements of moving heart attack patients by ambulance have not really been thought through.”

What the e-mails show

Dr Hodgkinson, wrote to Simon Griffith, the SCG's associate director, on May 22, and said: “Not all ambulances have a paramedic and so intravenous opiates may not be able to be administered until a paramedic meets the ambulance on the roadside.

“This means that some patients may not receive pain relief for up to 20 minutes.”

He said his A&E colleagues agreed with his concerns and added that he had even consulted the Medical Defence Union over the “moral and ethical dilemma” of being instructed to put all emergency heart attack patients in ambulances and send them to specialist centres in Norwich, Papworth and Basildon.

Dr Hodgkinson went on to say: “This will place Suffolk patients at almost double the mortality (death rates) of anyone inside 90 minutes simply because of their distance from the centres.”

And his last paragraph said: “I remain unconvinced that the proposed new model of care is best for all the patients that I see in the Ipswich Hospital NHS Trust.”

Meanwhile Dr McNab wrote in an e-mail, also to Mr Griffith: “The front-door clinicians do not feel that this is a model that they can work with. They believe if a patient dies on transfer they will be exposed to criticism for poor judgement.”

And he added: “The emergency physicians expressed concern that these guidelines were based upon retrospective or registry data rather than based on high quality evidence.”

East of England Ambulance Service's response

A spokeswoman for the service said: “The ambulance service operates to a set of clinical protocols that dictate a course of action as soon as the patient has been assessed.

“If technicians are first on scene and recognise an MI (heart attack) they immediately request paramedic backup. If assessed as an MI on the 999 call if the closest responding unit does not have a paramedic on board, one will be dispatched at the same time.

“Technicians have the ability to administer pain relief using Entonox, which supplies analgesic pain relief and oxygen at the same time. Opiates, such as morphine, require paramedics to undertake a clinical procedure and preparation before the drug can be given.

“Even then crews will still offer Entonox first as it is a quicker way of giving pain relief at the outset.”