General practitioners and emergency treatment for patients with suspected myocardial infarction: last chance for excellence?

Pre-hospital coronary care usually consists of a medically staffed coronary care ambulance going into the community from a hospital base, as pioneered in Northern Ireland. In today's medicopolitical and economic climate, this model is not viable in mainland United Kingdom. Current proposals seem to favour a 'scoop and run' policy for heart attack victims, that utilizes the ambulance service but bypasses the general practitioner. Since the majority of telephone calls from people with suspected myocardial infarction are directed to general practitioners, a preferable alternative would be a 'stay and stabilize' strategy that uses the existing referral pattern and builds on general practitioners' medical education and skills. The role of the general practitioner in the management of patients with suspected myocardial infarction is discussed.