PMID- 20682955
OWN - NLM
STAT- MEDLINE
DCOM- 20111027
LR  - 20161125
IS  - 1472-0213 (Electronic)
IS  - 1472-0205 (Linking)
VI  - 28
IP  - 8
DP  - 2011 Aug
TI  - Paramedic decision making: prehospital thrombolysis and beyond.
PG  - 700-2
LID - 10.1136/emj.2009.083766 [doi]
AB  - BACKGROUND: Mortality from acute myocardial infarction is influenced by the speed 
      at which reperfusion therapy is delivered. In the U.K., prehospital thrombolysis 
      (PHT), administered by paramedics, has been developed to improve call to needle 
      (CTN) times. Recently, it has been shown in randomised trials that mortality can 
      be further reduced by primary percutaneous coronary intervention (PPCI). This 
      project was developed to assess current ST-elevation myocardial infarction 
      practice in a district general hospital and to prepare paramedics for PPCI. 
      METHODS: Data were collected prospectively over a 12-month period for all 
      patients who received thrombolysis for a presumed myocardial infarct. The primary 
      outcome measures for each case were who delivered the thrombolysis, either the 
      paramedic crew or the hospital, and if the patient did not receive PHT the reason 
      why not. Secondary outcome measures included the CTN time. RESULTS: 153 patients 
      received thrombolysis over the time period (99 men, 54 women, mean age 66 +/- 15 
      years). Of this group, 55 patients received PHT (35.9%) with a median CTN time of 
      36 min (inter-quartile range (IQR) 30-42 min). The commonest reason for exclusion 
      from receiving PHT was that the patient's history did not fit the eligibility 
      criteria (25% of cases). CONCLUSIONS: Paramedics are able to deliver PHT promptly 
      and safely. With the focus now on PPCI, it is anticipated that not only will 
      paramedics be able to select patients for delivery to a heart attack centre for 
      PPCI, they will be selecting many more patients for this treatment than have up 
      to now received PHT.
FAU - Smith, Alyson M
AU  - Smith AM
AD  - Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield, UK.
FAU - Hardy, Pamela J
AU  - Hardy PJ
FAU - Sandler, David A
AU  - Sandler DA
FAU - Cooke, Justin
AU  - Cooke J
LA  - eng
PT  - Journal Article
DEP - 20100803
PL  - England
TA  - Emerg Med J
JT  - Emergency medicine journal : EMJ
JID - 100963089
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Clinical Competence
MH  - Decision Making
MH  - Emergency Medical Services/*methods/standards
MH  - *Emergency Medical Technicians
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/diagnosis/*therapy
MH  - Prospective Studies
MH  - *Thrombolytic Therapy
MH  - Time Factors
MH  - United Kingdom
EDAT- 2010/08/05 06:00
MHDA- 2011/10/28 06:00
CRDT- 2010/08/05 06:00
PHST- 2010/08/05 06:00 [entrez]
PHST- 2010/08/05 06:00 [pubmed]
PHST- 2011/10/28 06:00 [medline]
AID - emj.2009.083766 [pii]
AID - 10.1136/emj.2009.083766 [doi]
PST - ppublish
SO  - Emerg Med J. 2011 Aug;28(8):700-2. doi: 10.1136/emj.2009.083766. Epub 2010 Aug 3.