I, like many other Highland GPs, perform prehospital thrombolysis (although
in my patient populations your talking about 1 every 2 years).
I've been trying to get one of the companies (like SP services) to design a
thrombolysis pack such as a backpack with a forerunner defib and portable 12
lead (eg: seca 3000 interpretive) but I've not had much success. The new
FRED defib can transmit 12 lead ECGs but not print them out locally.
The call to needle time can be greatly reduced by prehospital thrombolysis
in ANY area, including urban. (It's interesting to watch the A+E people use
the same arguments to keep thrombolysis away from paramedics/GPs that CCU
cardiologists tried to use to keep it away from A+E!).
You can take a history, give o2/asprin/diamorphine/metoclopramide, do a 12
lead ECG, check exclusion criteria (laminated card in the 12 lead box) and
thrombolyse (with a bolus thrombolytic) in about 20 minutes. I don't leave
the scene until the 12 lead is done.
That gives a call to needle time of 20 minutes + my response time.
This was confirmed in a recent study in Scotland, so there is little doubt
in my mind that prehospital thrombolysis reduces call to needle time
significantly, but the variables that needs to be looked at are:
1. Can specially trained paramedics safely sort out thrombolysis criteria?
2. Would it be better to use prehospital physicians who would be called to
all chest pains?
3. Are bolus thrombolytics as effective and as safe as the traditional
4. Are the increased costs involved justified?
(sorry Rowley - It appears I sent this to you personally and not the list!
Not intended, it just happened your message was the first that came to hand
to "reply" to and I was too lazy to re-write the subject and address. You
might want to post your reply to the list as well)
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