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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]