Around 150 nationally. Just shy of 50 in our patch, which is around 1 million. Currently thrombolysing at a rate of one every 5 days, predicted and budgeted to rise to one every 2.5 days. Currently exploring avenues for identifying patients pre-hosp where thrombolysis is contra-indicated to transport directly to on-call cath lab, but some way to go on that front. Anton In message <[log in to unmask]> "Black, John" <[log in to unmask]> writes: > 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]