Anton,

What sort of numbers of patients have benefited from prehospital
thrombolysis nationally and in your patch to date?

John Black

-----Original Message-----
From: [log in to unmask]
[mailto:[log in to unmask]]
Sent: 21 June 2003 14:46
To: [log in to unmask]
Subject: Re: AMI/CHD role

Latest national audit data on patients who are thrombolysed pre-hosp is a
average pain to call time of 83 minutes - admittedly, these patients are not
typical chest pain patients, but this is well within the 3 hours when
thrombolysis is likely to have a marked effect.  We are beginning to
regularly see pain to needle times of less than an hour with pre-hosp
thrombolysis patients; unsurprisingly, they do very well with respect to ST
segment and pain resolution.

Anton

In message <[log in to unmask]> Adrian Boyle
<[log in to unmask]> writes:
> Hi Katherine, I agree with Bill Bailey, huffing and puffing about 10
minutes
> is pretty futile when the biggest delays are getting people to seek
medical
> care from the onset of pain. I have sat through a number of local audits
> where the biggest delays seem to be be the patient calling GPs or taking a
> few rennies, there is also some qualitative literature as to why people
with
> diagnosed ischaemic heart disease present late with MIs. I think the real
> way forward is through improving public awareness about symptoms of heart
> disease. Unfortunately this would result in an increased workload without
> any readily measurable targets. Oh well
> Adrian
>   -----Original Message-----
>   From: Accident and Emergency Academic List
> [mailto:[log in to unmask]]On Behalf Of richard BAILEY
>   Sent: Friday, June 06, 2003 10:22 AM
>   To: [log in to unmask]
>   Subject: Re: AMI/CHD role
>
>
>   Hi Katherine
>   I wonder if you could obtain some clarity [and hopefully common sense]
re
> the 20 v 30 min door to needle target for thrombolysis. I am encouraged
that
> the taskforce share my [and I would venture the vast majority of Emergency
> Physicians] view that a reduction to 20 mins would be futile and
potentially
> counter-productive. However, "recognition" of this fact is insufficient if
> the 20 min target still exists. My Trust, along with many others, is
> obsessive about meeting targets. If 20 minutes is the target they will
pour
> all of our scarce resource into achieving this instead of focusing on the
> much more important 60 min target. The managers here were under the
> impression [apparently mistaken] that the 20 min target had been scrapped,
> and all of our targets for 2003-04 refer to a 30 min target.
>   Does the steering group have enough clout to enforce maintenance of the
> more sensible 30 min target? Either way clarity about this issue would be
> appreciated.
>
>   Best wishes, Bill
>     ----- Original Message -----
>     From: Katherine Henderson
>     To: Bill Bailey
>     Sent: Friday, June 06, 2003 12:23 AM
>     Subject: AMI/CHD role
>
>
>     Dear Emergency Medicine Colleagues,
>
>     Some of you may remember that I sent round a mailing when I joined the
> national steering group of the CHD Collaborative - the operational spear
of
> the CHD NSF. One thing always leads to another and I now sit on the
> Department of Health CHD Taskforce and today attended my first steering
> group meeting of MINAP (replacing Roger Evans who previously attended). I
am
> the only Emergency Physician on these bodies so feel it is important that
my
> colleagues are aware that I am there.
>
>     Current hot themes are
>
>       a.. The 60 minute target is the one that counts - with a 10%
> improvement in this year on year from a base line which will be published
> with the public MINAP report in June.
>       b..
>       c.. A recognition that 20 minutes v 30 minutes does not make a huge
> difference but the 20 minute target still exists.
>       d..
>       e.. Concern that everyone needs to realise that the 60 minute target
> is only achievable with some pretty radical prehospital thinking. All the
> improvements have come so far from the in hospital phase. Hence the
> pre-hospital thrombolysis enthusiasm- the only alternative is much shorter
> pre hospital times.
>       f..
>       g.. A unclear commitment to PCI - massive concerns about cardiology
> numbers etc
>       h..
>       i.. A view that ACS patients are really the ones we will need to
worry
> about - MINAP is starting to get some data but not done anything with it
> yet.
>
>     If anyone at any point wants to raise an issue please let me know and
I
> will do my best. I am pretty new to this level of discussion and am
finding
> my feet. However being a female clinician who actually thrombolyses
patients
> regularly does give me some unique characteristics and insights in the new
> exiting world of the great and the good!!!!
>
>     Dr Katherine Henderson
>     Consultant in Emergency Medicine
>     Homerton Hospital
>     [log in to unmask]