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PRE-HOSPITAL THROMBOLYSIS IN SWEDEN 2000. 85 EMERGENCY HOSPITALS 65 ECG-TRANSMISSION 38 PRE-HOSPITAL THROMBOLYSIS 37 RETEPLAS 1 ALTEPLAS or RETEPLAS NATIONAL DATABASE . AMBULANCE SERVICES DALECARLIA. YEAR 2000 NUMBER OF EMERGENCY HOSPITALS-decreasing
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PRE-HOSPITAL THROMBOLYSISINSWEDEN 2000 85 EMERGENCY HOSPITALS 65 ECG-TRANSMISSION 38 PRE-HOSPITAL THROMBOLYSIS 37 RETEPLAS 1 ALTEPLAS or RETEPLAS NATIONAL DATABASE
AMBULANCE SERVICES DALECARLIA YEAR 2000 NUMBER OF EMERGENCY HOSPITALS-decreasing number of transport. -increasing longer distances number of critically ill (ICU-pat.) -increasing
AMBULANCE SERVICESDALECARLIA YEAR 2000 DEMANDS NUMBER OF AMBULANCES-increasing DIFFERENT VEHICLES COMPETENCE TELEMEDICINE,GPS HELICOPTERS
AMBULANCE SERVICESDALECARLIA 32 VEHICLES 16 - ”24-HOURS” 6 - ”DAILY” 10 - ”RESERVE” 220 EMPLOYEES ”PARAMEDICS” OR ”NURSES” ”DOCTORS” (ANESTH./CARDIOL.)
AMBULANCE SERVICESDALECARLIA EMERGENCY HOSPITALS EMERGENCY DEP AT ”CENTRAL HOSPITAL IN FALUN” AMBULANCES SOS-CENTRAL CBD MEDICAL-ADVICE
AMBULANCE SERVICESDALECARLIA PREPAREDNESS 90 % WITHIN 30 MINUTES CBD GPS NUMBER OF VEHICLES
TELEMEDICINE MEDIUM NMT GSM MOBITEX ( TETRA )
CONTAINER AMBULANCE LOADING CAPACITY BATTERY CAPACITY GENERATOR CAPACITY MEDICAL GAS CAPACITY ”ICU-EQUIPMENT” WORKING ENVIRONMENT COMFORT SAFETY ACCESSIBILITY ( 4WD)
TELEMEDICINE EQUIPMENT: ¤ STATIONARY/MOBILE ¤ 2 WAY COMMUNIKATION ¤ OTHER PARAMETERS THAN 12-LEAD ECG ¤ COMPATIBILYTY REGIONAL HOSPITALS ICU-MONITORS DIGITAL JOURNALS
EDUCATION NURSES A & E CCU/ICU PRIMARY CARE AMBULANCE DOCTORS SOS-CENTRAL 600 PERSONS
EDUCATIONAMBULANCE 1ST DAY PATOPHYSIOLOGY TIMEASPECTS ECG TREATMENT THROMBOLYSIS/PCI EQUIPMENT MOBIMED/GPS
EDUCATIONAMBULANCE 2ND DAY HOMESTATION REHEARSAL TRAINING EXAMINATION TOTAL 10 HOURS
AMI in DALARNA 395/100.000./YEAR 1100 AMI /YEAR (282.OOO INHIBITANTS) 500-550 AMI/YEAR at THE CENTRAL HOSPITAL in FALUN
CALL-TO-NEEDLE TIME in AMBULANCE MEDIAN 43 MIN CALL-ARRIVAL 8 ARRIVAL-ECG 16 ECG-THROMBOLYSIS 19
SYMPTOM-TO –NEEDLE TIME YEAR HOURS:MIN(MEDIAN) 1997 3 : 40 1998 2 : 50 1999 2 : 30
Patient fall I. 47-year female Call 14:05 Pulse 40/min Bp 70 syst. ECG 14:31 Case 1
Thrombolys 14:36 Call to needle time 31 min. Symptom to thrombolys 36 min. Patient fall I. Case1
CASE 245 YEAR FEMALE • PAIN 9:30 • CALL 9:35 • AMB.ARR. 9:50 • ECG (INFERIOR INFARCT.) 10:05 • LAB.ARR. 10:30 • OPEN VESSEL 10:40
CASE 2PRIMARY PTCA OCCLUSION
CASE 2PRIMARY PTCA OPEN OPEN
MISTAKE PERICARDITIS CHOLECYSTITIS (with LBBB) AORTICDISSEKTION(THORAX)
Pre-hospital thrombolysis1998-1999 N=78 MORTALITY PREHOSPITAL 0 MORTALITY CCU/WARD 4 MORTALITY 30 DAYS 6
CONCLUSIONS EARLY DIAGNOSIS FAST TRACK to CCU/PCI PRE-HOSPITAL TREATMENT of AMI