In message <[log in to unmask]>, Robbie Coull
<[log in to unmask]> writes
>The call to needle time can be greatly reduced by prehospital thrombolysis
>in ANY area, including urban. (It's interesting to watch the A+E people use
>the same arguments to keep thrombolysis away from paramedics/GPs that CCU
>cardiologists tried to use to keep it away from A+E!).
Touche!
>You can take a history, give o2/asprin/diamorphine/metoclopramide, do a 12
>lead ECG, check exclusion criteria (laminated card in the 12 lead box) and
>thrombolyse (with a bolus thrombolytic) in about 20 minutes. I don't leave
>the scene until the 12 lead is done.
Sounds like a smooth system. What bolus lytic do you use (rt-PA)? Do you
leave after the 12-lead is done and before lysis is given?
>That gives a call to needle time of 20 minutes + my response time.
How long is your typical response time? This is important in trying to
apply the results to our area where most patients should be in A&E in 25
minutes from call, maybe with a 12-lead recorded en-route, and we can
perform the above management (with more staff / equipment etc.) perhaps
even quicker than 20 minutes. Certainly local GPs would not be willing
or able to attend "?MI" calls like this at most times of the day. Their
current response to such a request (from patient or ambulance staff)
would be to rapidly get to A&E, and quite right too.
>4. Are the increased costs involved justified?
The last point may not have the same answer if transport to hospital
times are (say) 45 minutes, as opposed to (say) 15 minutes.
Dr G Ray
Staff Grade
A&E
Sussex
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