The two sentences which quoted cardiologists were stating different things.
First statement... Where cardiologists have an input into thrombolysis
programs the system has been proved to work very well. The Brighton
Experience in the late 180's is a prime example of this. The impetus behind
Brighton experience was a cardiologist - not an ambulance manager or an SHO.
Second statement... I didn't suggest we have cardiologists on tap in CCU or
anywhere else. I was referring to a study by Bouten et al, done in Holland
where a cardiologist was involved. Norris R (United Kingdom Heart Attack
Study) stated that it didn't matter where thrombolysis was administered as
long as the organisation was in place to ensure that the drug was
administered sooner rather than later by a suitably qualified person.
Brighton has been doing it in A&E since the 1980's by SHO's.
I agree with you that A&E is the correct place to administer thrombolysis -
I never said anything to the contrary. The original question was asking if
there was benefit in prehospital 12 lead ECGs (yes there is) not where
should thrombolysis be administered.
Mike Bjarkoy
Paramedic
Sussex
-----Original Message-----
From: [log in to unmask]
[mailto:[log in to unmask]]On Behalf Of Andrew G Hobart
Sent: 16 July 2000 18:25
To: [log in to unmask]
Subject: Re: Pre-hospital ECGs
Michael Bjarkoy wrote:
> ......If a cardiologist has enough power to influence the ambulance crews
and
> the
> recieving hospital then much can be achieved.....
> .....the Dutch experience which relied on this system or
> telephone transmission to a cardiologist in CCU proved to be safe......
Most of us subscribing to this list work in the NHS.
We do not have Cardiologists in CCU.
We have junior medicalcardiology SHOs who amongst their other duties
cover CCU. They are not Cardiologists.
In a large DGH or teaching Hospital there will be a Cardiologist on call
at
home. In other hospitals there will be a General Physician on call at
home.
Patients with an emergency medical condition should be taken to the
Emergency
Department.
If they dont get the right treatment than that department needs to
improve. The
answer is not to dilute experience by skimming off some cases to by pass
the
AED.
--
Andrew
_______________________________________________________
Andrew Hobart FRCS FFAEM
Birmingham
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