HELP does not get to heart attack victims in Singapore fast enough - resulting in a survival rate of only 2.7 per cent.

And what slows down ambulance crews unnecessarily is anti-social behaviour - traffic which won't get out of the way, and even lift passengers who do not feel they should give up their space to paramedics.

It takes paramedics between 8.6 minutes and 14 minutes from the time they get a call for help till they arrive at the patient's side.

'After 10 minutes, the chances of survival are practically zero,' said emergency medicine specialist Fatimah Lateef, who led a study to see if there were ways to save more people who get heart attacks at home or in the community.

Every minute's delay in getting help cuts a victim's chance of survival by 10 per cent.

Dr Fatimah, a senior consultant at the Singapore General Hospital, has followed ambulance teams on calls and says delays are sometimes caused by other people behaving badly.

'Sometimes, people refuse to come out of lifts, even after we tell them it's a medical emergency,' she recounted.

Lifts need to be cleared to make space for paramedics and bulky equipment like a stretcher.

'The paramedics have to wait for another lift, or for the same lift to return. That wastes critical time,' she said.

Some vehicles still refuse to give way to an ambulance which has its lights on and sirens wailing.

Lieutenant-Colonel N. Subhas of the Singapore Civil Defence Force (SCDF) said 13 motorists were fined for obstructing an ambulance in the first six months of this year - up from nine in the same period last year.

The SCDF gets 100 emergency calls a month for heart attacks.

But only one in 37 people who suffer a heart attack at home or in the community survive.

Though the survival rate here is comparable to New York's, it is a far cry from the 50 per cent survival rate of people who get heart attacks in Cook County in Seattle, casinos in Las Vegas or Chicago's O'Hare Airport.

The difference is the large number of people in these places who are trained in resuscitation, and the easy availability of defibrillators - a machine that sends electric shocks to restart the heart.

Patients living in high-rise flats generally have a longer wait. It takes paramedics about 1 minute 45 seconds longer to get to them, according to an earlier study.

Dr Fatimah said families of patients can speed things up by holding the lift ready for paramedics, and directing them to the correct house. The minutes saved could make a vital difference.

On-the-spot help also makes a vital difference between life and death, she said. About 900 people die of heart attacks each year. More than 500 are dead before they arrive at a hospital.

The team of emergency medicine doctors from several public hospitals, who studied over 2,000 out-of-hospital heart attacks, suggested that families of patients with heart diseases learn CPR, as six in 10 attacks occur at home.

It also recommended having more defibrillators in public areas, such as in shopping centres. These machines cost $2,000 to $3,000 each and are fairly easy to use.

The results of the study were published recently in the Singapore Medical Journal.

It also found that significantly more people get heart attacks at 8am and 7pm. While this pattern is seen in the West, this is the first time it has been shown to occur here too.

Dr Fatimah said knowing these peaks can help emergency doctors and the SCDF plan resource allocation better, including having more vehicles and paramedics available at these times.

She and her team are currently studying if there are certain geographical areas in the country where more heart attacks take place - possibly because there are more elderly people living there.

If so, it might improve response times if ambulances are stationed in those places, she said.

salma@sph.com.sg

This story was first published in The Straits Times on Oct 30, 2008.