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----- Original Message ----- From: <[log in to unmask] > > Some good discussion about urban pre-hosp thrombolysis in EMJ, so won't regurg that, suffice to say that there is some evid to suggest that where hosp systems can't achieve Door to Needle in 20 minutes, we need to consider pre-hosp thrombolysis. > > I think there is a separate debate about whether we would prefer more resources put into cath labs with 24 hours primary PTCA capability rather than into pre-hosp thrombolysis or reducing Door to Needle times. Ah, but there still needs to be speed in both the prehospital and hospital arena, if you're to get your patient to cath labs in time. In other words these targets, and the resources that go with them, have encouraged the development of a culture of efficiency leading up to the final point of thrombolysis (which is the easy bit that only takes a minute at the end). Remove the prehospital and hospital targets (and resources) and the patients won't get to the cath labs for hours... AF