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Pre-hospital Thrombolysis in the UK - looking ahead

Pre-hospital Thrombolysis in the UK - looking ahead. Richard Vincent Royal Sussex County Hospital, Brighton. Pre-hospital thrombolysis. Why attempt it? What are the possibilities? Where are we now? What of the future?. Pre-hospital thrombolysis. Why attempt it?.

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Pre-hospital Thrombolysis in the UK - looking ahead

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  1. Pre-hospital Thrombolysis in the UK- looking ahead Richard Vincent Royal Sussex County Hospital, Brighton

  2. Pre-hospital thrombolysis • Why attempt it? • What are the possibilities? • Where are we now? • What of the future?

  3. Pre-hospital thrombolysis • Why attempt it?

  4. Pre-hospital thrombolysis Why attempt it? • The argument of natural history

  5. Pre-hospital thrombolysis Why attempt it? • The argument of natural history • Persuasive clinical trials

  6. Pre-hospital thrombolysis Lives saved per 1000 patients treated of those with ST or LBBB 0 - 1 hr 65 1 - 2 hrs 37 2 - 3 hrs 26 3 - 6 hrs 29 Boersma, Lancet 1996

  7. Pre-hospital thrombolysis Reducing delay early after the onset of symptoms (A) gives greater benefit than reducing delay later (B)

  8. Pre-hospital thrombolysis Why attempt it? • The argument of natural history • Persuasive clinical trials • The enthusiasm of a few

  9. Pre-hospital thrombolysis Why attempt it? • The argument of natural history • Persuasive clinical trials • The enthusiasm of a few • Improved practicality

  10. Pre-hospital thrombolysis Why attempt it? • The argument of natural history • Persuasive clinical trials • The enthusiasm of a few • Improved practicality • The NHS plan and others

  11. Pre-hospital thrombolysis • Why attempt it? • What are the possibilities?

  12. Pre-hospital thrombolysis What are the possibilities? recognise clinical AMI then: • Report clinical and ECG data to hospital

  13. Pre-hospital thrombolysis What are the possibilities? recognise clinical AMI then: • Report clinical and ECG data to hospital • Report AMI and transmit ECG to hospital

  14. Pre-hospital thrombolysis What are the possibilities? recognise clinical AMI then: • Report clinical and ECG data to hospital • Report AMI and transmit ECG to hospital • Seek authorisation for on-site thrombolysis

  15. Pre-hospital thrombolysis What are the possibilities? recognise clinical AMI then: • Report clinical and ECG data to hospital • Report AMI and transmit ECG to hospital • Seek authorisation for on-site thrombolysis • Liaise with GP on site

  16. Pre-hospital thrombolysis What are the possibilities? recognise clinical AMI then: • Report clinical and ECG data to hospital • Report AMI and transmit ECG to hospital • Seek authorisation for on-site thrombolysis • Liaise with GP on site • Decide and treat without outside advice

  17. Pre-hospital thrombolysis • Why attempt it? • What are the possibilities? • Where are we now?

  18. Pre-hospital thrombolysis Where are we now? • A growing level of interest

  19. Pre-hospital thrombolysis Where are we now? • A growing level of interest • A growing level of consultation

  20. Pre-hospital thrombolysis Where are we now? • A growing level of interest • A growing level of consultation • A new level of trust

  21. Pre-hospital thrombolysis Where are we now? • A growing level of interest • A growing level of consultation • A new level of trust • Greater permission to use drugs

  22. Pre-hospital thrombolysis Where are we now? • A growing level of interest • A growing level of consultation • A new level of trust • Greater permission to use drugs • On-going technical development (equipment and drugs)

  23. Pre-hospital thrombolysis Ambulance trusts with an interest Reporting clinical and ECG data to hospital 27 Reporting AMI and transmitting ECG to hospital 24 Seeking authorisation for on-site thrombolysis 27 Liasing with GP on site 17 Deciding and treating without outside advice 21 JRCALC, Summer 2000

  24. Pre-hospital thrombolysis • Why attempt it? • What are the possibilities? • Where are we now? • What of the future?

  25. Pre-hospital thrombolysis The future? • Continued technical development

  26. Pre-hospital thrombolysis The future? • Continued technical development • Increasing determination to make pre-hospital successful including the use of thrombolytics

  27. Pre-hospital thrombolysis The future? • Continued technical development • Increasing determination to make pre-hospital successful including the use of thrombolytics • A hard look at some challenging questions….

  28. Pre-hospital thrombolysis The future will also contain MISTAKES

  29. Pre-hospital thrombolysis Challenging questions • Organisation?

  30. Pre-hospital thrombolysis Challenging questions • Organisation? • Ownership?

  31. Pre-hospital thrombolysis Challenging questions • Organisation? • Ownership? • Competence?

  32. Pre-hospital thrombolysis Challenging questions • Organisation? • Ownership? • Competence? • Training?

  33. Pre-hospital thrombolysis Challenging questions • Organisation? • Ownership? • Competence? • Training? • Psychology?

  34. Pre-hospital thrombolysis Treating VF with a shock • Diagnose death + appropriate ECG • Four observations + gross ECG changes • No contra-indications • Immediate, visible benefit • Patient can’t get worse

  35. Pre-hospital thrombolysis Treating VF with a shock • Diagnose death + appropriate ECG • Four observations + gross ECG changes • No contra-indications • Immediate, visible benefit • Patient can’t get worse Treating AMI with thrombolysis • Diagnose MI + appropriate ECG • Twenty observations + subtle ECG changes • Important contra-indications • Delayed, invisible benefit • Patient will sometimes get worse - early or late

  36. Pre-hospital thrombolysis Challenging questions • Organisation? • Ownership? • Competence? • Training? • Psychology? • Audit?

  37. Pre-hospital thrombolysis So now….. • Keep discussing • Pray for wisdom

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