Mike Replies
What Gautum and others have said on this and previous threads is absolutley
true. We must be very cautious who we allow thrombolysis to be in the hands
of and when it is appropriate to administer the drug in the community. There
are tremendous benefits but should only be considered once all other avenues
of treatment are exhausted.
In Sussex, as with many areas in England (Wales and Scotland are
geographically different), most of the time prehospital thrombolysis would
be inappropriate at this moment in time. I think I can speak for the
majority of ambulance services in stating that our prime objective is to
reduce call to hopsital times in line with national proposals (the ambulance
persepective) while the hospitals reduce thier door to needle times
significantly.
Only if this system fails to generate targets set would prehospital
thombolysis be considered and then only with full support and agreement of
all concerned and after correct training and clinical auditing to ensure
paramedic competance. To consider prehospital thrombolysis with current IHCD
training standards would be premature and not in the best inerests of the
patient, paramedic or future UK thrombolytic programmes.
It is interesting to speak to paramedics and here their reaction to the
concept of prehospital thrombolysis. Most are very anxious about such a drug
being on their list - and rightly so. I see this as a credit to the
professionalism of my profession. Many ambulance services are looking at
additional training for there staff. Initially to reduce call to needle
times but looking at prehospital thrombolysis if it is warrented.
I am waiting for permission to publish - I have written a 20,000 word
dissertation titled "Does evidence based medicine support prehospital
thrombolysis by UK paramedics" When I have the permission from the
University I shall upload it to one of my web sites so you chaps can review
it if you wish.
Mike Bjarkoy
Paramedic
Sussex
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