Immediate Counterattack

Modern medicine has a battery of devices that greatly reduce the dangers of heart attacks -- provided they are used in time. The electrocardiograph gives the physician a continuous moving pic ture of how the damaged heart is behaving. A simple oxygen system will do the patient's breathing for him. If his heart stops, electric paddles restart it.

If it lapses into an ineffectual, twitching action (fibrillation), an electrical defibrillator restores a beat. If that beat is still not right, an electrical pacemaker can take over.

So far, such equipment has been kept in hospitals. But most heart attacks occur at home. It usually takes hours to get a patient to the equipment, though the first few minutes and hours after a heart attack are the most critical. Top U.S. Government physicians believe that in the case of at least one patient with a heart-attack history, namely Lyndon Johnson, the equipment should be installed in his home--the White House. Since that is not practicable for Everyman, the alternative is to rush the equipment to the patient.

There is just one place in the world where that is being done consistently and effectively--Northern Ireland's dour capital city of Belfast. At the Royal Victoria Hospital, Cardiologist James F. Pantridge combed the records and found that 60% of heart-attack deaths occurred within the first hour.

Many victims got no benefit from the hospital's well-equipped, well-staffed intensive-care unit, because one of every four was dead on arrival.

To Dr. Pantridge, it seemed silly to keep the intensive-care unit in the hospital. The thing to do, he reasoned, was to take both equipment and expertise to the patient as fast as possible; he installed the gear in an ambulance. Now, a telephone call to the Royal Victoria gets the mobile intensive-care unit to the patient's door promptly--in four out of five cases, within 15 minutes. Out step a doctor and a nurse, usually with two medical students, armed with the life-saving devices with which they give the most urgent emergency care.

Though the Belfast doctors make a fetish of avoiding "haste or fuss," the patient is soon on his way to the hospital in the mobile unit, with his heart monitored all the way. If it stops en route, the doctors can restart it, just as they would in the hospital. The unit has proved so effective that in its first 15 months of operation not one of the 312 heart patients taken to the Royal Victoria has died in transit. Once in the hospital, many--perhaps most--of them have fared better because superior treatment was started so promptly.

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