BMJ  2003;327 (5 July), doi:10.1136/bmj.327.7405.0-c

Prehospital thrombolysis by paramedics saves time

Early thrombolysis for acute myocardial infarction has been shown unequivocally to improve outcome, but the current national target of delivery of thrombolysis in less than 60 minutes is difficult to meet in rural areas. Pedley and colleagues (p 22) report on a system of prehospital thrombolysis delivered by paramedics, with remote decision support provided by the local accident and emergency department using a mobile telemetry link. This resulted in a reduction in median call to needle time for rural patients of 73 minutes compared with a similar group of patients treated in the conventional manner. In another paper this week, Keeling and colleagues (p 27) report that autonomous prehospital thrombolysis can be effectively and safely administered by paramedics. Their feasibility study showed an average time saving of 48 minutes from the call to drug administration.

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