Thanyou for your reply.
Although the GREAT study is of significance, I will be addressing supportive evidence later. All I am interested in at the moment is the perceived or actual blocks which are present and holding back pre-hospital thrombolysis. I am being very specific about my needs at present.
I will be discussing the other things you mentioned at a later date.
Maybe I should have put something like this in the e-mail:
I wish to discuss at length the following
1. Blocks what is presently holding us back. Our fears and doubts about prehospital thrombolysis
2. The present limitations and ways we can get around them. ie; training, funding, closer collaboration with cardiologists and paramedics
3. What training is required to being paramedics up to speed.
4. Which drugs should we be looking at and what are the alternatives.
5. What evidence is out there to support or not this arguement.
I would like to address the above topics one at a time, at length, so that no gaps are left in the potential way forward on this subject. The first subject I would like to cover is BLOCKS - some medical and non medical personnel believe prehospital thrombolysis to be either dangerous, inappropriate or too expensive. Could the list discuss this at length
Mike Bjarkoy
-----Original Message-----
From: [log in to unmask] [mailto:[log in to unmask]]On Behalf Of
[log in to unmask]
Sent: 30 October 1999 15:47
To: [log in to unmask]
Subject: Re: [ECO] Thrombolysis - prehospital administration by
paramedics
Michael
Interested in your paper. Why do you feel that the GREAT study is off at a
tangent? Surely it puts forward a good argument for your proposals. I
believe Kings, London ran a study (around 92-93) using a designated
prehospital thrombolysis team in an urban area — do you have the results of
this?
Also, have a look at Cooke's editorial in this weeks BMJ - mainly trauma
related but has some useful references and a workable approach.
Are you looking at urban or rural paramedic thrombolysis — and do you
perceive any difference in need. What criteria would you use for decision
making (presumably thrombolysing autonomously rather than using online
medical advice)? What agent do you suggest to be most suitable? What
special training is available?
I appreciate you're probably busy and may not have time to cover all the
points. I wholeheartedly agree with early thrombolysis — "time is
myocardium" — but wonder how many years away it is, realistically, when a
large proportion (no figures today) of A&E units still don't thrombolyse in
the department, so the patient has to wait to be moved to CCU
Best Wishes,
Paul Rees
(not sure what to say about who I am any more — see our rudimentary <A
HREF="http://members.aol.com/drpscrees/BASICS.html">HEARTSITE</A>
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