title: Collaborative decision-making between paramedics and CCU nurses based on 12-lead ECG telemetry expedites the delivery of thrombolysis in ST elevation myocardial infarction.
abstract: OBJECTIVE
  To describe a prehospital thrombolysis (PHT) and expedited inhospital thrombolysis (IHT) programme in south-east Scotland using prehospital 12-lead ECG recordings transmitted by telemetry and autonomous paramedic-administered thrombolysis with decision support being provided by coronary care nurses.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  Three hospitals in south-east Scotland covering a population of 778,468 served by 54 ambulance vehicles.
  
  
  METHODS
  11,840 patients who telephoned the ambulance service with "chest pain" over 20 months, during which 812 patients were admitted with ST segment elevation myocardial infarction (STEMI).
  
  
  METHODS
  All calls and cardiac/potential cardiac calls to the ambulance service, type/time of patient presentation, symptoms/call/door-to-thrombolysis times.
  
  
  RESULTS
  Of the 11,840 calls to the ambulance service for chest pain over 20 months of the initiative, 60% were cardiac/potentially cardiac-related by Scottish Ambulance Service triage. ST segment elevation was present in 8% of the 5150 12-lead ECGs transmitted by paramedics to the ECG receiving station in the CCU. Over the 20 months, 812 patients were admitted to the three hospitals with STEMI and 71% received thrombolysis. Median symptom-to-thrombolysis times were 91, 148 and 184 min, respectively, in the PHT, telemetry-facilitated IHT and self-presenting IHT groups. Median call-to-needle time for the PHT group was 40 min. In 2/146 cases the cardiologists judged that the patient should not have been administered PHT.
  
  
  CONCLUSIONS
  Based on prehospital 12-lead ECG telemetry, it is possible for paramedics and CCU nurses to conduct live reperfusion decision-making in patients with STEMI, with resultant benefits in symptoms-to-thrombolysis time.
authors.affiliation: Directorate of Cardiology, The Royal Infirmary of Edinburgh, Edinburgh, UK. scott.mclean@luht.scot.nhs.uk
authors.forename: S
authors.initials: S
authors.lastname: McLean
authors.forename: G
authors.initials: G
authors.lastname: Egan
authors.forename: P
authors.initials: P
authors.lastname: Connor
authors.forename: A D
authors.initials: AD
authors.lastname: Flapan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000552:Ambulances; D003299:Cooperative Behavior; D003325:Coronary Care Units; D003657:Decision Making; D004562:Electrocardiography; D004634:Emergency Medical Technicians; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy*; D009741:Nursing Staff, Hospital; D012189:Retrospective Studies; D017216:Telemedicine / Q000379:methods*; D013686:Telemetry / Q000379:methods*; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors