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Prospective observational cohort study of time saved by prehospital thrombolysis for ST elevation myocardial infarction delivered by paramedics

BMJ 2003; 327 doi: (Published 03 July 2003) Cite this as: BMJ 2003;327:22
  1. David K Pedley, specialist registrar accident and emergency (david.pedley{at},
  2. Kim Bissett, audit nurse, chest pain service1,
  3. Elizabeth M Connolly, nurse practitioner, chest pain service1,
  4. Carol G Goodman, clinical group manager, medicine and cardiovascular group1,
  5. Ian Golding, divisional officer2,
  6. T H Pringle, consultant cardiologist1,
  7. G P McNeill, consultant cardiologist1,
  8. S D Pringle, consultant cardiologist1,
  9. M C Jones, consultant in acute medicine1
  1. 1Ninewells Hospital and Medical School, Dundee DD1 9SY
  2. 2Scottish Ambulance Service, Dundee DD3 8PQ
  1. Correspondence to: D K Pedley
  • Accepted 9 June 2003


Objectives To evaluate a system of prehospital thrombolysis, delivered by paramedics, in meeting the national service framework's targets for the management of acute myocardial infarction.

Design Prospective observational cohort study comparing patients with suspected acute myocardial infarction considered for thrombolysis in the prehospital environment with patients treated in hospital.

Setting The catchment area of a large teaching hospital, including urban and rural areas.

Participants 201 patients presenting concurrently over a 12 month period who had changes to the electrocardiogram that were diagnostic of acute myocardial infarction or who received thrombolysis for suspected acute myocardial infarction.

Main outcome measures Time from first medical contact to initiation of thrombolysis (call to needle time), number of patients given thrombolysis appropriately, and all cause mortality in hospital.

Results The median call to needle time for patients treated before arriving in hospital (n=28) was 52 (95% confidence interval 41 to 62) minutes. Patients from similar rural areas who were treated in hospital (n=43) had a median time of 125 (104 to 140) minutes. This represents a median time saved of 73 minutes (P < 0.001). Sixty minutes after medical contact 64% of patients (18/28) treated before arrival in hospital had received thrombolysis; this compares with 4% of patients (2/43) in a cohort from similar areas. Median call to needle time for patients from urban areas (n=107) was 80 (78 to 93) minutes. Myocardial infarction was confirmed in 89% of patients (25/28) who had received prehospital thrombolysis; this compares with 92% (138/150) in the two groups of patients receiving thrombolysis in hospital.

Conclusions Thrombolysis delivered by paramedics with support from the base hospital can meet the national targets for early thrombolysis. The system has been shown to work well and can be introduced without delay.


  • Funding Changes to services in Angus as outlined in this paper were approved and funded by the then Tayside Health Board on the basis that paramedic led thrombolysis services had already been implemented successfully in continental Europe. It was, however, a provision of the decision that the new service was audited. This paper presents the result of that audit.

  • Competing interests None declared.

  • Ethical approval The comparison of anonymised results from service provision was not thought to require formal ethical approval. This opinion was discussed with the chairman of the local ethics committee, and the view was endorsed.

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