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----- Original Message ----- From: "Mike Bjarkoy" Subject: Re: prehospital thrombolysis > 1. Is £1,000 for a helicopter trip that much more expensive than £700-800 for single shot lytics when outcomes for patients that we could include into the PTCA programme probably far outweigh the numbers we could fit into prehospital fibrinolytic programmes. Not convinced in an urban environment Mike. Most of our patients are whisked to our department by land ambulance in around five to ten minutes; I expect a helicopter would take around 20 to 30 minutes to do the same trip. But if you were to centralise PTCA into one or two centres in London, then the argument gets more interesting. However the infarcts are a very small proportion of all chest pains, and it would probably be very uneconomical to fly all chest pains to one big centre. And if you make your diagnosis first, then it makes no sense to fly them, when you can 'lyse them on the spot. And five or ten minutes can make a difference to an individual patient. Patients don't infarct gradually over 90 minutes. Their ECGs suggest that the actual process of infarction takes only around five minutes, somewhere during that window of 30 to 90 minutes from pain onset. That's why I agree that the 20-minute target, for barn-door MIs, is worth going for. In the rural environment, I expect journeys longer than around 30 miles would be much faster by helicopter, but something like 90% of Britain's population lives closer than that to their local A&E department. And thrombolysis is only £400 a shot, and that's for tenecteplase, others are cheaper. I can't see the current system changing much... Adrian Fogarty