Newcastle and North Tyneside
Local Medical Committee
(www.nntlmc.co.uk) (email: mailto:contact@nntlmc.co.uk)
Chief Executive Officer
Dr George Rae
47 Marine Avenue
Whitley Bay
NE26 1LZ
Tel. 0191 2514548
Executive Officer
Dr David Black
2 Betts Avenue
Benwell
NE15 6TQ
Tel. 0191 2742767
Executive Officer
Dr Ken Megson
3 Front Street
Tynemouth
NE30 4RG
Tel. 07803 989960
January 2013
Dear Colleagues
Re: Chest Pain Patients to be Referred to the 999 Service from GP Premises
We have recently been contacted by the North East Ambulance Service with us some advice on how
they would like patients with suspected MIs to be treat on GP premises before the arrival of the
paramedics.
Occasionally practitioners will come across patients at the surgery, who have a history of chest pain
and need prompt hospital assessment/subsequent management. As the treatment of MIs is time
critical there is a standard practice for the surgery staff to request a 999 ambulance. While awaiting
the ambulance, a patient with an infarct/severe ischaemia is at risk of abrupt deterioration due to
ventricular arrhythmias, and for this reason they should be observed in a suitable clinical area until
the paramedics arrive. It is also recommended that Aspirin should be given as soon as possible and
that vital signs should be measured and an ECG should be recorded, if practicable.
Whilst it is best practice for an ECG to be recorded, we are aware that it is not always possible or
practical due to the availability of trained staff or the even the availability of an ECG machine.
We have attached a check list that has been prepared by the North East Ambulance Service for your
consideration, as we feel that this is good practice for all the surgeries within our area, and hopefully
all practices will adopt this procedure.
Best wishes.
Yours sincerely
Dr K Megson
CHECK LIST FOR A PATIENT WITH CHEST PAIN
WHO PRESENTS TO THE GP SURGERY
If a patient is seen in a GP surgery complaining of chest pain at rest that, if felt
by the GP or staff to be cardiac in nature (i.e. possible heart attack)
1)
A 999 call is made for a paramedic crew/8 minute response, then
2)
300mg aspirin is given unless patient on warfarin or has allergy to
aspirin, then
3)
An ECG is performed, where practicable, and vital signs recorded by any
available clinician where possible with no delay in paramedic assessment.
A member of staff stays with the patient until the crew arrive (typically a GP or
practice nurse, but could be any sensible person who can get help if patient
deteriorates suddenly).
The patient is cared for until paramedic crew arrive in a clinical area (e.g.
GP/nurse office/treatment room and not the general waiting room).
2