title: Prospective observational cohort study of time saved by prehospital thrombolysis for ST elevation myocardial infarction delivered by paramedics.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Prospective observational cohort study comparing patients with suspected acute myocardial infarction considered for thrombolysis in the prehospital environment with patients treated in hospital.
  
  
  METHODS
  The catchment area of a large teaching hospital, including urban and rural areas.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Ninewells Hospital and Medical School, Dundee DD1 9SY. david.pedley@tuht.scot.nhs.uk
authors.forename: David K
authors.initials: DK
authors.lastname: Pedley
authors.forename: Kim
authors.initials: K
authors.lastname: Bissett
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Connolly
authors.forename: Carol G
authors.initials: CG
authors.lastname: Goodman
authors.forename: Ian
authors.initials: I
authors.lastname: Golding
authors.forename: T H
authors.initials: TH
authors.lastname: Pringle
authors.forename: G P
authors.initials: GP
authors.lastname: McNeill
authors.forename: S D
authors.initials: SD
authors.lastname: Pringle
authors.forename: M C
authors.initials: MC
authors.lastname: Jones
mesh_terms: D002391:Catchment Area, Health; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality; D011446:Prospective Studies; D012423:Rural Health; D012606:Scotland; D015912:Thrombolytic Therapy / Q000379:methods* / Q000706:statistics & numerical data; D013997:Time Factors; D014187:Transportation of Patients; D014504:Urban Health