1. Minimising Critical Incidents in Myocardial Infarction in the Emergency Department Dr John Ryan

2. Important factors Pre-hospital Influences Triage Time to assessment Decision making Intervention Disposal

3. Pre-hospital Influences Beware the patient who arrives with a diagnosis Patients arrive with SYMPTOMS YOU make the Diagnosis Encourage early warning by paramedics

4. Triage Assume the worst Ask the right questions: Know the risk factors: Cigarettes Family History High Blood Pressure High Cholesterol Stress

5. Time to Assessment Minimise time to assessment: Perform ECG on the ambulance trolley Senior A&E doctor to screen chest pains on arrival Utilise advanced warning to gather relevant staff

6. Decision making Doctor must sign and time ECG is reviewed Do not allow procrastination Consultation only with seniors not peers

7. Intervention Have thrombolysis kit available Know the contra-indications to thrombolysis Check all drugs being administered with another person Check for allergies

8. Disposal Discharge to the right ward Do not allow juniors to discharge chest pain patients without supervision Ask for CCU bed early Ensure Defibrillator is close to hand BE PREPARED

9. Take away message TIME IS MUSCLE