What are the beliefs and attitudes of paramedics to prehospital thrombolysis? A questionnaire study.
BACKGROUND
The Ambulance Services have a critical role in the management of acute myocardial infarction (AMI). Paramedic delivered prehospital thrombolysis (PHT) has been proposed. To the authors' knowledge there has been no research carried out to ascertain the views of paramedics.


METHODS
The authors conducted a postal questionnaire study of 250 paramedics in the West Yorkshire Metropolitan Ambulance Service (WYMAS). This included the knowledge of risks and benefits of AMI treatments, and their views on possible paramedic delivered PHT.


RESULTS
193 paramedics replied (77%); of these 83% felt paramedics could deliver PHT, 67% felt thrombolysis was safe, and only 12% felt that paramedics should not carry out PHT. There was a similar preference towards autonomous PHT (42%) and telemetry with physician directed PHT (46%). 96% wanted a nationally recognised certificate. There were concerns regarding the risks of AMI treatment, with underestimates of the benefits of aspirin, and overestimates of the benefits of thrombolysis. They also greatly overestimated the risks of thrombolysis in terms of extra deaths (71%), and bleeding (90%).


CONCLUSIONS
The majority of paramedics in WYMAS responding to the questionnaire supported the principle of PHT. Concerns included the risks of thrombolytic treatment, training, and the medico-legal implications for them as individual paramedics. Models for paramedic thrombolysis for each ambulance service should include the views of paramedics.
Humphrey
J
J
Barnsley District General Hospital, Barnsley, UK.
Walker
A
A
Hassan
T B
TB
D000552:Ambulances; D000553:Ambulatory Care / Q000379:methods*; D001291:Attitude of Health Personnel; D004634:Emergency Medical Technicians / Q000193:education / Q000523:psychology*; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000523:psychology*