Pre-hospital Thrombolysis A View from the Front Line

1. Lancashire Ambulance ServiceNHS Trust Pre-hospital ThrombolysisA View from the Front Line Paul Bastow MA SRPara Clinical Effectiveness Manager

2. Treatment Flow ?2001 Thrombolysis A&E Chest pain Call for Help 999 On scene Leave CCU Scene Pain to Call Call to Needle Pain to Needle NHS

3. Focus Groups Consisting of: • Discussion on Paramedic 3 year Re-qualification courses • Group work with Clinical paramedic Tutors • Discussion with staff in Local CCU’s and A & E departments NHS

4. Identified Concerns • Turfism • Litigation • Increased time on scene • Will the receiving department always action the transmitted ECG’s • Debriefing in the case of an adverse reaction NHS

5. Identified Benefits • Better relationship between pre-hospital & secondary care • Patient receives treatment earlier • Increase our effectiveness • Will give the paramedic a higher professional profile • Increases patient life expectancy NHS

6. “A pre-hospital paramedic programme for identifying and treating thrombolysis-eligible patients requires intensive planning, retrospective feasibility work, implementation and monitoring to establish effectiveness” Myers RBH Can J Cardiology 1998 NHS

7. How Do We Achieve This? • Give staff the evidence • Commitment from the Trust’s involved • Phased introduction • Confidence in the system • Involvement of everybody at all stages NHS

8. The TEAM Approach • Training • Evaluation • Access to Outcomes • Medical Partnership NHS

9. The TEAM Approach By using the TEAM approach we can achieve Seamless Integrated Patient Care where Joint decision making takes place and all players are fully involved. NHS

10. Lancashire Ambulance ServiceNHS Trust Pre-hospital ThrombolysisA View from the Front Line Paul Bastow MA SRPara Clinical Effectiveness Manager