 |
 |
Hi all A few thoughts of my own - if you will allow... I gave APSAC once back in 1990 and since then have fought to get lysis on the road for us paramedics. So it may come as a bit of a surprise to everyone, after fighting for this drug to be avaialbe to people such as myself, to hear little 'ol me saying that I would prefer to see patients not recieving prehospital fibrinolytics and bypassing local A&E depts in favour of the cath labs.I have seen how they work the system in Seattle and they go straight to cath labs. The only people they do not lyse are those too big to get into the cath labs. The number of patients who will be eligible for prehospital thrombolysis will be minimal. I have been applying the questionnaire that JRCALC has put forward in one form or another since the late 1980's (pre-JRCALC recommendations) and this year only 2 people have been eligible. Door to needle times in some hospitals are still not wonderful. To my knowledge (anecdotal) the local hospital I run into still has door to needle times in excess of 30 - 45 minutes unless the patient is fortunate enough to be met by Doc who are switched on. The wasted time (if you could call it that) could possibly be better spent delivering the patient to definive mechaincal care - cath labs. I believe the way forward should be... All patient to go to central unit with cardiac specialties (PTCA). If the patient fits the paramedic format for lysis and is out in the sticks, then Reteplase would be administered as this doesn't preclude the patient from mechanical interventions. If they are outside the scope for PHT by paramedics i.e. recent surgery, known active bleed etc then I believe it is an even greater indication to take the patient to cardiac specialties. If most of the MI patients go to one very good unit instead of many mediocre units then there will be the volume of patients required to justify 24/7 PTCA. There is obviously one very big down side to all of this. If in the extra 15 - 20 minute running time suggests that the patients condition will dramatically deteriorate en-route then bypassing the local A&E unit may not be the best course of action. The other possibility is helicopter transport in. I know we only use these birds to get trauma in but is there any negative evidence to suggest why they cannot be used for AMIs. Theoretically it will increase stress - or will it?? just the rantings of a senile paramedic Mike