The pre-hospital phase of acute myocardial infarction: a national audit is needed in New Zealand.

The outcome of acute myocardial infarction is usually settled before the patient reaches hospital, because ventricular fibrillation, when it occurs, is most common soon after the onset of symptoms. Ventricular fibrillation can be treated as effectively by ambulance personnel as in hospital, and many more deaths can be prevented, mainly by timely defibrillation, for patients coming under ambulance care within 1 hour of onset than can be prevented by use of more recent treatment advances. Both patient performance in reporting symptoms promptly, and ambulance performance in responding to calls for help, need to be audited. A prolonged campaign to educate the public on the cause and symptoms of heart attack, and how to respond to them, is also necessary.