Traditionally senior doctors knocked off in the early evening and weren’t on deck again until the morning.
When Dr Murray Kirk, a chest physician, joined Palmerston North Hospital in 1963 fresh from working at a chest hospital in Wales, he immediately saw the need for round-the-clock specialist care for those patients who had, for example, been critically injured in motor vehicle accidents, or suffered overdoses, diabetic complications, or heart attacks.
“It was inconceivable to me that these patients were set aside in these critical hours following the event, and had to wait through the night before any treatment.
“I lobbied key people in the hospital and was able to set up a four-bed intensive care unit (ICU) in what was Ward 15. This was the first ICU in the country, although it was becoming clear that other hospitals were thinking along the same lines. While Auckland already had an acute respiratory unit, it did not cater for general intensive care patients.”
Heart patients needing resuscitation were put in ICU. In October 1966, Kirk and colleagues Peter Parkinson and John Wattie created a separate adjoining ward for cardiac patients – known as the coronary care unit (CCU). This was one of the first CCUs in New Zealand. The coronary and intensive care unit were side-by-side and shared the same staff. The ratio of staff to patient was one-to-one.
The aim of the new unit was to prevent sudden death by treating potentially lethal arrhythmias.
Heart disease is the second leading cause of death in New Zealand and monitoring a patient continuously is critical in the hours following a coronary incident.
When a patient was admitted they were immediately connected to a cardiac monitor and a diagnostic ECG was carried out. An intravenous line was then inserted so any drugs could be administered for abnormal heart rhythms. When chest pain ceased, patients were generally discharged from the unit within four to six days.
The CCU’s first patient was a man who had just been interviewed to be a hospital orderly. He had collapsed outside the operating theatres. Kirk said: “I remember this well. He was given rather vigorous cardiac massage, which unfortunately broke some ribs, but he survived. I understand, however, he died several years later.”
The effectiveness of the unit was soon proven with a detailed examination of cases admitted before and after its establishment. Among 100 cardiac cases from 1 January 1966 to 31 October 1966, which preceded the three-bed CCU, there were 34 deaths. Between November 1966 and 31 May 1967, 21 deaths were recorded, but 12 of these occurred outside the CCU. In addition, none of these 34 deaths was termed as ‘sudden’.
Kirk said: “The results showed a reduction in total hospital mortality, and a highly significant reduction in sudden death since the CCU had been functioning.”
By 1968 there were four beds in the CCU and not long after six beds plus nine ward beds for post coronary care and cardiac patients. In those days a hospital stay was four to five weeks. Now it is seven to 10 days.
Kirk makes it clear he is not a heart specialist. “I am a chest physician and later was involved in general hospital management. But I saw the need for a structure that would serve heart patients better, even though it was difficult to convince some medical staff that working through the night was necessary. I myself was often called up to the ICU/CCU at night, sometimes twice a night, to attend to patients. It’s what you do, as a physician. But in the early days it was difficult to convince people that this was part of our job. In addition, some surgeons even resented us ‘pinching’ patients from their surgical wards.”
Change, however, was needed and recognised. By 1968, Kirk had left CCU management to heart specialists such as John Willis, Neville Brooke and Des Dickson.
People became more aware of heart health in the 1970s when there were campaigns to lower cholesterol levels. This led to an increase in patient numbers as people became more aware of warning signs.
Today the six-bed Coronary Care/High Dependency Unit (CCU/HDU) caters for patients requiring a high level of specialised care.
Patients needing urgent interventional heart procedures, such as unblocking arteries, have always had to go to Wellington. But there is optimism that Palmerston North Hospital might get its own full cardiac care facilities within the next two years. Investigations are under way currently into the establishment of a new $4.5 million cardiac catheterisation laboratory (cath lab), which can deliver procedures such as balloon angioplasty and stents.
Time is of the essence, and with a cath lab, even more lives will be saved in future.