A system approach to intravenous thrombolysis in XXXX in community hospitals: the influence of paramedics.

@entity1 @entity1188 @entity158 @entity583 @entity204
During a 3-year period, intravenous streptokinase (IV STK) was given to 110 consecutive @entity1 ages 34-78 in the course of @entity583 ( @entity583 ) in three community hospitals served by the same paramedic system. 1.5 million units of IV STK was given over 30 minutes. Half of the @entity1 were brought to the hospital by paramedics. The average time from onset of @entity158 to administration of IV STK was 107 minutes in the paramedic group and 182 minutes for the others. Of 110 @entity1 , 98 (89%) showed clinical evidence of reperfusion and 94 of 106 @entity1 (89%) showed angiographic reperfusion. Angiography was performed from 1 to 10 days post- @entity583 . Mean time to angiography was 6 days for the first 58 @entity1 and 2 days for the last 52 @entity1 . In-hospital mortality was 2 of 110 @entity1 and there was 1 late @entity204 at 8 months for an overall 3-year mortality 2.7%. Of 86 @entity1 , 83 (96%) working before their @entity1188 are working now. Of 107 survivors, 96 (90%) are Functional Class I. CONCLUSIONS: (1) IV STK is safely administered in a high percentage of @entity583 @entity1 . (2) IV STK is safely administered in community hospitals. (3) Paramedics act as an early warning system and allow for earlier treatment than @entity1 presenting without paramedic involvement. (4) Successful coronary reperfusion with IV STK results in low mortality rates and minimizes functional disability. (5) A system-wide approach to reducing time to treatment in @entity583 may be the most influential factor in affecting morbidity and mortality.
