Prospective observational cohort study of time saved by prehospital thrombolysis for ST elevation XXXX delivered by paramedics.

@entity1 @entity583
OBJECTIVES: To evaluate a system of prehospital thrombolysis, delivered by paramedics, in meeting the national service framework's targets for the management of @entity583 . DESIGN: Prospective observational cohort study comparing @entity1 with suspected @entity583 considered for thrombolysis in the prehospital environment with @entity1 treated in hospital. SETTING: The catchment area of a large teaching hospital, including urban and rural areas. @entity1 : 201 @entity1 presenting concurrently over a 12 month period who had changes to the electrocardiogram that were diagnostic of @entity583 or who received thrombolysis for suspected @entity583 . MAIN OUTCOME MEASURES: Time from first medical contact to initiation of thrombolysis (call to needle time), number of @entity1 given thrombolysis appropriately, and all cause mortality in hospital. RESULTS: The median call to needle time for @entity1 treated before arriving in hospital (n=28) was 52 (95% confidence interval 41 to 62) minutes. @entity1 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 @entity1 (18/28) treated before arrival in hospital had received thrombolysis; this compares with 4% of @entity1 (2/43) in a cohort from similar areas. Median call to needle time for @entity1 from urban areas (n=107) was 80 (78 to 93) minutes. @entity583 was confirmed in 89% of @entity1 (25/28) who had received prehospital thrombolysis; this compares with 92% (138/150) in the two groups of @entity1 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.
