Clot busters. The future of EMS thrombolytics

The importance of early identification and treatment of patients experiencing an AMI is clearly beneficial. Studies have shown that the time from pain onset to hospital administration of thrombolytic therapy can be reduced simply by early identification of patient eligibility by paramedics and notification of the receiving hospitals--as well as more efficient patient management after arrival at the ED. The limitations of thrombolytic therapy also may be related, in part, to patient denial of symptoms and reluctance to seek emergency assistance. To widen the net of patients who can receive thrombolytic therapy, extensive research has been and is being conducted to integrate the prehospital phase into the treatment window. The practicality of upgrading all EMS systems to provide thrombolytic therapy depends on many factors. EMS directors must accept the responsibility for the prehospital care delivered. Although the diagnostic accuracy is high and complications are relatively low when compared to the risk, the current legal environment in the United States may limit the willingness of some directors to promote a prehospital thrombolytic program. Additionally, the low yield of patients may not justify the significant capital outlay required to adequately train personnel and outfit ambulances with required telemetry systems. At a minimum, however, EMS programs can improve their ability to rapidly identify those patients who may be eligible for thrombolytic therapy.