A quick response makes all the difference. But how many of us are equipped to cope, asks Anne Lucey
Patsy Cronin thanks his lucky stars he wasn't at home in Killorglin a year ago. He was in San Francisco when he was struck by chest pain. It turned out to be a heart attack. Cronin is certain he survived because he was 10 minutes from St Mary's Medical Center, a teaching hospital in the city.
Had he been in Co Kerry he would have had to travel 20 tortuous, and probably torturous, miles to the nearest acute hospital. "I was lucky," says Cronin - who is back at work as a trade-union official - after a brisk six-mile walk along Rossbeigh strand.
Even had he not been near St Mary's, Cronin may have benefited from one of the automated external defibrillators fitted in public buildings around the city; by delivering brief but powerful electric shocks, to interrupt abnormal heartbeats, they allow the heart's natural rhythm to regain control. Almost every state in the US has made them compulsory, to help cardiac casualties. For the price of a good laptop computer they are making life-and-death differences.
They have made a difference in Ireland, too, at the likes of Dublin Airport, which decided they were a good idea. They are not compulsory, however, and the Department of Health and Children says it has no plans to make them so.
In fact Ireland is lagging behind in many aspects of tackling our unhealthy hearts, according to a recent meeting of the Irish Cardiac Society. It's not as if there isn't a problem.
Although it's not as prevalent as it was 20 years ago, heart disease is still our biggest killer, claiming 13,000 lives a year - the worst record for the illness in the EU.
For younger Irish men, those under the age of 65, 46 per 100,000 die from coronary heart disease - almost double the EU average. More women die prematurely from cardiovascular disease than from any other cause except cancer.
We also have far fewer cardiologists per head of population than any other developed country - although the appointment of 17 new cardiologists should bring us up from the bottom of the pile.
There are steps we can take, however. One of the keys to surviving a heart attack or other problem of the circulatory system is to follow the chain of survival, as it is known: dial 999, ensure early cardiopulmonary resuscitation (CPR) or early defibrillation, and get to an acute medical centre as quickly as possible. The way people are treated in the "golden hour" after the onset of a heart attack makes all the difference.
Unfortunately, the chain breaks all too often; two-thirds of people who die from heart problems do so in the community, away from hospitals. Rural communities in particular lack the facilities to respond.
According to a survey by a Cork doctor, golf courses may be a notable problem. Dr Con Kelleher, from Macroom, discovered that 21 people, mainly men in their 40s and 50s, died on courses in Cork and Kerry over a four-year period. Only one of the 46 clubs in his survey, in Tralee, had life-saving equipment.
"In fairness to the golf courses, modern defibrillators have only recently become available," he says. But staff at almost two-thirds of the clubs he spoke to had no training in cardiopulmonary resuscitation. Could golfers be dying elsewhere in this country for want of better preparedness?
GPs and health boards in rural areas now want to ensure that every community includes somebody with a basic knowledge of life-saving skills, particularly cardiopulmonary resuscitation. The Southern Health Board, for example, is piloting a "first-responder programme" on the Dingle peninsula - 30 miles from the nearest acute hospital - with the help of Dr Micheal Fanning, a local GP, and the ambulance service. "Community awareness of what is a heart attack is the first step, followed by a call to the emergency services or for help," says Dr Fanning, who wants rural communities to take more active roles, working and training together alongside ambulance staff.
Perhaps in part because of the number of remote communities it contains, Kerry has a high rate of male death from heart attack - 141 per 100,000 men in 2001. Cork, which shares the same health board, had one of 116 per 100,000, a considerably better figure. About half of the deaths in the community occurred within two hours, emphasising the importance of a rapid response, according to a recent report of the director of public health, Dr Elizabeth Keane.
Pat Hanafin, chairman of the Association of Ambulance Personnel of Ireland, believes that golf courses, restaurants, hotels and other facilities should have someone to hand for that vital 10 to 15 minutes until the ambulance arrives. "If you do the work first, you can actually cut down on the time the patient has to spend in hospital," says Hanafin, who is also a member of the Pre-Hospital Emergency Care Council, a statutory agency set up to develop professional standards for the ambulance services.
"The main thing is to keep a cool head. CPR instructions can even be given over the phone from the ambulance control centre. Doing a CPR on a chest, if done right, makes a difference and keeps the heart alive. Even a half-effort can keep the heart alive. The main thing is, don't give up if someone around you has a heart attack."
Hanafin is also pushing for a helicopter ambulance service. "With our roads, our traffic, we need the helicopter for that final link in the chain, to get the patient to the acute hospital. Two in the country would do us."
For Patsy Cronin, a focus on local services can't come soon enough. "We are talking too much about centres of excellence inside in the cities. Every community should have their own specialised units for dealing with heart disease." If it means installing public-access defibrillators, every minute gained could improve patients' chances of survival.
Croi, the West of Ireland Cardiology Foundation, is launching details of public access defibrillation and first responder programmes at the Radisson SAS Hotel in Galway tomorrow