To avoid delays in treating patients, 12 heart attack management clusters — including four in the city — are coming up in Tamil Nadu. Doctors and paramedics are being trained at each of these clusters to put in place a Standard Operating Protocol for management of heart attacks.
The success of the Tamil Nadu STEMI (ST-Elevation Myocardial Infarction) Study that tested the “hub-and-spoke model” during 2013-14 is being replicated across the State. Under this model, there were four hubs — the Government Stanley Medical College Hospital, Kovai Medical Centre, Madras Medical Mission and Christian Medical College — and each had five to six spoke hospitals.
“The best treatment for a patient suffering from STEMI is immediate angiogram and primary angioplasty. To offer this to every patient, we need cardiologists and cath labs. But this is not possible in every nook and corner of the State. So, we adopted pharmaco-invasive therapy. A patient, on reaching a spoke hospital, is given thrombolytic therapy within 30 minutes and referred to a hub for angiogram, and angioplasty if needed, within 24 hours,” said G. Justin Paul, professor of cardiology, Madras Medical College, and T.N. State STEMI coordinator. A hub hospital has cardiologists and a cath lab, while the spoke hospital will have an intensive care unit and facility to provide thrombolytic therapy in which the clot responsible for causing heart attack is dissolved.
The State government is forming 12 STEMI clusters, with the hubs at the Madras Medical College, Stanley Medical College, Kilpauk Medical College, Tamil Nadu Government Multi Super Specialty Hospital, Madurai Medical College, Chengalpet Medical College, Coimbatore Medical College, Government Mohan Kumaramangalam Medical College, Salem, KAP Medical College, Tiruchi, Thanjavur Medical College, Tirunelveli Medical College and Vellore Medical College. Under this programme, each hub would have five to 10 spoke hospitals, such as taluk hospitals. A hub with the spoke hospitals is a heart attack management cluster. “Eleven new cath labs are being established at a cost of ₹43 crore. Five labs at the Tirunelveli, Coimbatore, Chengalpet, Tiruchi and Stanley medical colleges have been inaugurated,” he said.
Ambulance network
With the 108 ambulance network being an integral part of the programme, there would be no transportation delay for patients, he said. The protocol for managing STEMI patients was ready for publication, he said, adding that they were in the process of procuring 300 STEMI kits for spoke hospitals and 108 ambulances. Through this, the ECG and vital parameters of a patient can be monitored and transmitted to the hub hospital from wherever it is recorded. Around 60 doctors and 40 paramedics were trained during a session at the Rajiv Gandhi Government General Hospital recently.
