Paper

Safety and feasibility of prehospital thrombolysis carried out by paramedics

BMJ 2003; 327 doi: 10.1136/bmj.327.7405.27 (Published 3 July 2003)
Cite this as: BMJ 2003;327:27
  1. Phil Keeling, consultant cardiologist (phil.keeling@nhs.net)1,
  2. Debbie Hughes, clinical nurse specialist1,
  3. Linnie Price, research coordinator2,
  4. Steve Shaw, senior lecturer in statistics3,
  5. Andy Barton, RDSU coordinator1
  1. 1South Devon Healthcare Trust, Lawes Bridge, Torquay TQ2 7AA
  2. 2Research and Development Support Unit, Peninsula Medical School, Plymouth PL6 8BX
  3. 3Department of Mathematics and Statistics, University of Plymouth, Plymouth PL4 8AA
  1. Correspondence to: P Keeling
  • Accepted 23 June 2003

Introduction

The benefits of thrombolysis in patients with acute myocardial infarction are time dependent, with a potential 48% reduction in mortality if treatment is received within an hour of onset of symptoms.1 The benefits diminish thereafter. However the “call to needle” standard set by the national service framework2 has been achieved for only a third of patients nationally because of lengthy ambulance journeys and delays in hospital. Prehospital thrombolysis may be the most feasible means of achieving timely reperfusion, and all published studies have shown the accuracy of diagnosis, patient selection, and administration of thrombolysis.3 The Joint Royal Colleges Ambulance Liaison Committee favours autonomous prehospital thrombolysis by paramedics as a long term objective.4 We tested the feasibility of physician assisted and autonomous models of paramedic prehospital thrombolysis.M

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Summary statistics for time from event to response (minutes)

Methods and results

All 64 paramedics serving the study hospital took part in the study. Of these, 48 (75%) received formal training in recording 12 lead electrocardiograms, diagnosing ST …

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