Background: Acute myocardial infarction (AMI) without treatment has a high mortality and morbidity rate. The success of cardiac reperfusion strategies is significantly influenced by the time interval between symptom onset and restoration of myocardial blood flow. This project enables paramedics to administer thrombolytic and anticoagulation treatment to patients with ST Elevation Myocardial Infarction (STEMI) significantly reducing the time to reperfusion.
Methods: Ambulance identified communities where timely access to health facilities was limited. One hundred and thirty (130) paramedics from within these communities were trained and equipped to recognise and treat patients presenting with STEMI. Paramedics acquire and electronically transmit an ECG to a cardiologist for confirmation of STEMI pattern. Paramedics use a protocol to deliver thrombolytic and anticoagulation medication, in the case of confirmed STEMI before transporting the patient to the appropriate hospital.
Findings:
• The project established clinical, logistical and communication foundations for the delivery pre hospital thrombolysis by paramedics
• Over 900 patients suffering an acute cardiac event have benefited from having a cardiologist interpret their ECG prior to hospital arrival
• 54 patients received pre hospital thrombolytic treatment by Ambulance paramedics.
• No significant adverse events have been associated with this project
• The median time from paramedic arrival at scene to administration of thrombolytic is 30 minutes
• The youngest patient thrombolysed is 37 years of age with the median age being 62 years.
Conclusions: It is feasible for paramedics, assisted by expert review of ECG, to appropriately administer thrombolytic therapy prior to transfer to hospital.