In message <[log in to unmask]>, Robbie Coull <[log in to unmask]> writes
(re. pre-hospital lysis in rural areas)...
>Different practices use different lytics - urokinase is the most popular.
Isn't Urokinase less effective at restoring artery patency than Strep and t-PA?
>My patients are between 30 to 150 minutes from hospital with an additonal
>ambulance response time of up to 90 minutes (can be longer if we have to
>wait for air or lifeboat transport - can rarely be measured in days if the
>weather is very bad). So call to door time can be anything from 40 minutes
>to 4 hours or more.
This is highly relevant. We are blessed with call-to-A&E times of 30-45 minutes
(guesstimate). All our chest pain patients get 12-leads within a few minutes of arrival
which are shown immediately to a doctor (even if they are in the middle of stitching etc.).
Good Hx + ECG signs= IMEMDIATELY drop what you're doing (even stitching etc.) and get on
with lysis. When senior A&E docs involved, we should (!) be able to get lysis underway
within 15 mins of arrival. The call-to-lysis times should still be <1hr, which is
acceptable. My point is that pre-hosp 12-leads and lysis might improve times by say 15
minutes round here, and this may not be so easy to justify on cost-benefit grounds when
including the extra paramedic time "off the road" (shouldn't they be rushing to the next
chest pain having safely delivered the previous patient to A&E?) and possibly more
difficulty dealing with occasional complications pre-hospital.
>once you arrive
>at A+E you have to wait for staff to be available - like Mark I have had to
>treat seriously ill patients myself in A+E when there were no staff
>available.
I'm appalled you have such an inadequate local A&E service. Ours is far from perfect but
can't see the above ever happening here. See comments above on how we aim to handle ?MIs.
I'm not saying pre-hospital lysis has no place in our area, but would urge caution on those
who are recommending it as a panacea based on studies in very different settings, such as
your, where it clearly works very well for the patient's benefit.
Interestingly, if College recommendations are pushed through, the call-to-A&E times are
likely to double round here, and patients may be delivered to over-stretched A&E
deaprtments with equally inadequate resources as those you describe. This is described as
progress and quality improvement! (don't mind me, I'm just paranoid, bitter and twisted).
Thank you for your insight from your experience.
Dr G Ray
Staff Grade
A&E
Sussex
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