A stratified system of coronary care.

A DOCUMENT was published in the May 1971 issue of CIRCULATION (43: A-171) by the Inter-Society Commission for Heart Disease Resources reappraising the optimal care of patients with acute myocardial infarction. The Commission proposed a stratified system of coronary care, which consists of three levels or categories of medical facilities: (1) life support units or stations, (2) coronary care units with adjacent intermediate care units, and (3) Regional Reference Centers. Since the operation of coronary care units (CCU) is now almost a standard component of patient care in all hospitals, and the important aspects of staffing, facilities, and operation are described in detail in this and other documents, no further comments are necessary. On the other hand, the concepts of life support units, intermediate care units, and Regional Reference Centers deserve special consideration. Because of the very high fatality rate from acute myocardial infarction during the first few hours, the members of the Commission believe that it is imperative to shorten the delay between onset and the availability of optimal coronary care. Both public and professional education are needed. Messages directed to the public should be simple, clear, and direct. The American Heart Association and its affiliates have already alerted the lay public through the use of pamphlets describing effectively the warning signs of heart attack and the measures that should be taken in order to avoid unnecessary delay. In parallel with intensive public and professional education, mechanisms should be provided for rapid entry of patients into the first level or category of coronary care-life support units-where adequate personnel and facilities are provided for continuous surveil-