The word ‘3 hour tight window period’ sounds sensational and dramatic. But for a family physician, who is managing a patient of myocardial infarction or a stroke due to brain infarct with intravenous thrombolytic treatment, this window period is important as the chances of the patient surviving and/or with a healthier myocardium or the brain matter are excellent in this period.

Unfortunately, the free government and municipal hospitals have no funds to offer this treatment. This makes the above situation more complicated. The following are my suggestions:

1. All family physicians should identify the shortest route (in peak traffic time) to a private hospital, which is well equipped to give thrombolytic treatment.
2. Unless the ambulance station is very near, it may be wrong to wait for the ambulance because you are wasting precious minutes. If the doctor thinks, he is acting smart by calling for a special cardiac ambulance, which are hardly a dozen in number in the city of Mumbai, then the 3 hour tight period will certainly be lost.
3. People should be encouraged to keep cash money (Rs. 20,000 - 30,000/-) handy. This is because on arrival in the hospital, they expect a cash deposit immediately, otherwise they refuse to admit the patient and nothing can be done legally against the hospital.
4. The doctor/relative who is accompanying the patient in the vehicle should use his mobile effectively and contact that particular hospital to make sure that there is bed available in ICU. If not, he should contact the next nearest hospital.
5. A private nursing home cannot ideally replace the private five star hospitals and would only be the second choice. This is because for a heart patient, a serial enzyme estimation of troponin and CPK and an urgent coronary angiography and primary angioplasty facilities should be available. In a stroke patient the CT scan, MRI and 2-D Echo (with facility of TEE) should be available within this 3 hour tight window period.
6. After reaching the hospital, one relative should go to pay the money and the second should see that the patient is guided to the ICU as early as possible.
7. The patient’s relative should not try to save the specialist’s night visit fees, which may be about Rs. 2000/- or more because the junior doctor might miss a contra-indication of thrombolytic treatment and either accentuate chances of death in a stroke patient or may not be able to effectively handle the arrhythmias in a case of myocardial infarction.

Finally the ‘3 hour tight window period’ is most beneficial to indoor patients of a five star private hospital, who happen to develop complication of myocardial infarction or stroke during hospital stay.