Problems With Requesting a Hospital

April 17 -- Imagine suddenly experiencing a searing chest pain, accompanied by sweating and nausea. Your left arm is numb.

You are having a heart attack, or what doctors call an acute myocardial infarction (MI). Your sense of weakness is overwhelming as you gradually become more short of breath.

But you are prepared. You have already discussed the unthinkable in advance with your doctor. You calmly reach for an aspirin tablet and chew it as you were instructed.

A family member or co-worker notices you appear very ill, and you acknowledge saying, "call an ambulance," as those around you appear very worried.

"It will only be a few minutes," sounds reassuring, and you briefly recall the reports of two major medical studies released this month that showed overall improved outcome for acute MI patients with urgent cardiac catheterization — that is, if they are able to meet the two-hour "door to balloon" guideline for performing angioplasty.

An editorial published this week in the Journal of the American Medical Association even suggests that Emergency Medical Services (EMS) bypass local hospitals in favor of the nearest cardiac center, using the "trauma center model, in which patients with major trauma are triaged not to the nearest hospital but to the nearest trauma center."

Yes, you want to get help ideally at a nearby facility capable of aggressive cardiac therapy like angioplasty, stents and even coronary bypass surgery.

Paramedics arrive promptly. Oxygen in your nostrils makes your breathing easier. Nitroglycerin under your tongue eases your pain, and you feel good enough to inquire about the nearest cardiac center, as the ambulance crew lets it slip your EKG monitor does not look good.

Still, everything goes smoothly as you are now on a stretcher being taken to the ambulance, and then you are told that your neighborhood emergency departments are themselves on bypass.

"You mean they are sending us to another hospital?" you ask incredulously. "Yeah, we'll have to take you to..." Immediately you toy with the foolish idea of jumping off the stretcher and asking someone, anyone to drive you to your destination of choice by car.