Dear Michael,
I have considerable experience in pre hosp thrombolysis in a rural area
by GPs. Please phone me to discuss. Dr. David Hillebrandt, Devon: 01409
253692. Cheers.
In message <[log in to unmask]>, Michael
Bjarkoy <[log in to unmask]> writes
>Thanyou for your reply.
>Although the GREAT study is of significance, I will be addressing supportive
>evidence later. All I am interested in at the moment is the perceived or actual
>blocks which are present and holding back pre-hospital thrombolysis. I am being
>very specific about my needs at present.
>
>I will be discussing the other things you mentioned at a later date.
>
>Maybe I should have put something like this in the e-mail:
>
>I wish to discuss at length the following
>1. Blocks what is presently holding us back. Our fears and doubts about
>prehospital thrombolysis
>2. The present limitations and ways we can get around them. ie; training,
>funding, closer collaboration with cardiologists and paramedics
>3. What training is required to being paramedics up to speed.
>4. Which drugs should we be looking at and what are the alternatives.
>5. What evidence is out there to support or not this arguement.
>
>I would like to address the above topics one at a time, at length, so that no
>gaps are left in the potential way forward on this subject. The first subject I
>would like to cover is BLOCKS - some medical and non medical personnel believe
>prehospital thrombolysis to be either dangerous, inappropriate or too expensive.
>Could the list discuss this at length
>
>Mike Bjarkoy
>
>-----Original Message-----
>From: [log in to unmask] [mailto:[log in to unmask]]On Behalf Of
>[log in to unmask]
>Sent: 30 October 1999 15:47
>To: [log in to unmask]
>Subject: Re: [ECO] Thrombolysis - prehospital administration by
>paramedics
>
>
>Michael
>Interested in your paper. Why do you feel that the GREAT study is off at a
>tangent? Surely it puts forward a good argument for your proposals. I
>believe Kings, London ran a study (around 92-93) using a designated
>prehospital thrombolysis team in an urban area do you have the results of
>this?
>Also, have a look at Cooke's editorial in this weeks BMJ - mainly trauma
>related but has some useful references and a workable approach.
>Are you looking at urban or rural paramedic thrombolysis and do you
>perceive any difference in need. What criteria would you use for decision
>making (presumably thrombolysing autonomously rather than using online
>medical advice)? What agent do you suggest to be most suitable? What
>special training is available?
>I appreciate you're probably busy and may not have time to cover all the
>points. I wholeheartedly agree with early thrombolysis "time is
>myocardium" but wonder how many years away it is, realistically, when a
>large proportion (no figures today) of A&E units still don't thrombolyse in
>the department, so the patient has to wait to be moved to CCU
>Best Wishes,
>Paul Rees
>(not sure what to say about who I am any more see our rudimentary <A
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--
Rich Page
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