Related Experiment Video
Updated: Jun 10, 2026
05:52
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Paramedic decision making: prehospital thrombolysis and beyond
Alyson M Smith1, Pamela J Hardy, David A Sandler
1Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield, UK.
Emergency Medicine Journal : EMJ
|August 5, 2010
Summary
Paramedics can safely administer prehospital thrombolysis (PHT), reducing call-to-needle times for ST-elevation myocardial infarction. This study prepares paramedics for primary percutaneous coronary intervention (PPCI), aiming to increase patient selection for this superior treatment.
Area of Science:
- Cardiology
- Emergency Medicine
- Prehospital Care
Background:
- Mortality from acute myocardial infarction (AMI) is time-dependent, emphasizing the need for rapid reperfusion therapy.
- Prehospital thrombolysis (PHT) administered by paramedics in the UK aims to decrease call-to-needle (CTN) times.
- Primary percutaneous coronary intervention (PPCI) has demonstrated superior mortality reduction compared to PHT.
Purpose of the Study:
- To evaluate current ST-elevation myocardial infarction (STEMI) management in a district general hospital.
- To assess the feasibility and safety of paramedic-administered PHT.
- To prepare paramedics for the implementation of PPCI.
Main Methods:
- Prospective data collection over 12 months for patients receiving thrombolysis for suspected myocardial infarction.
- Primary outcomes: thrombolysis provider (paramedic vs. hospital) and reasons for PHT exclusion.
- Secondary outcome: CTN time.
Main Results:
- 153 patients received thrombolysis; 55 (35.9%) received PHT with a median CTN of 36 minutes.
- The most frequent reason for PHT exclusion was ineligibility based on patient history (25%).
- Paramedic crews administered PHT promptly and safely.
Conclusions:
- Paramedics are capable of delivering PHT efficiently and safely.
- Paramedic selection of patients for PPCI is expected to increase treatment rates.
- The study supports paramedic involvement in advanced STEMI care pathways.
Related Concept Videos
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
01:28Acute Coronary Syndrome IV: Interprofessional Care
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management
Pharmacologic intervention is crucial in treating cardiac arrest patients during ACLS or Advanced Cardiovascular Life Support. The ACLS algorithms guide the administration of specific drugs based on the patient's cardiac arrest rhythm, which includes pulseless ventricular tachycardia (VT), ventricular fibrillation (VF), asystole, and pulseless electrical activity (PEA).EpinephrineIndication: Epinephrine is the first-line drug for all cardiac arrest rhythms.Mechanism of Action: Epinephrine...
01:29Venous Thrombosis III: Interprofessional Care
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
01:27Pulmonary Embolism III: Nursing Management
A pulmonary embolism occurs when a thrombus, amniotic fluid, tumor tissue, fat, or air embolus blocks one or more pulmonary arteries. Effective nursing management and patient education are crucial for improving outcomes and preventing recurrence.Nursing management starts with obtaining a comprehensive patient history, particularly noting any history of deep vein thrombosis (DVT). Assess for clinical manifestations, including dyspnea, chest pain, crackles, heart murmurs, and signs of right-sided...
01:23Cardiopulmonary Resuscitation III: AED Use
Introduction to AEDAn Automated External Defibrillator (AED) is a portable medical device that analyzes the heart's rhythm and, if necessary, delivers an electrical shock to help the heart re-establish an effective rhythm during sudden cardiac arrest (SCA). SCA occurs when the heart suddenly and unexpectedly stops beating, leading to a loss of blood flow to the brain and other vital organs. In such emergencies, time is of the essence, and using an AED, combined with Cardiopulmonary...