ArticleEmergency medicine journal : EMJ2002
Prehospital thrombolysis: lessons from Sweden and their application to the United Kingdom.
Article in Emergency medicine journal : EMJ, 2002. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Using evidence briefs to support future implementation planning: the case of early fibrinolysis for myocardial infarction and rehabilitation for the amputee patient in Colombia.Health research policy and systems · 2026Article
- Barriers to the implementation of prehospital thrombolysis in the treatment of ST-segment elevation myocardial infarction in South Africa: An exploratory inquiry.African journal of emergency medicine : Revue africaine de la medecine d'urgence · 2020Article
- Primary Angioplasty for the Treatment of Acute ST-Segment Elevated Myocardial Infarction: An Evidence-Based Analysis.Ontario health technology assessment series · 2004Article
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Authors and funding
3 authors.
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Abstract
objectiveTo study the successful implementation of paramedic administered prehospital thrombolysis in Sweden, and to consider the implications of this for the UK.
methodsA series of research visits were undertaken, including visits to Uppsala Hospital and dispatch centre, ambulance stations in several counties of Sweden and Dalarna County, which has one of the longest experiences of telemedicine supported prehospital thrombolysis in Europe. Data relating to prehospital thrombolysis, stages in successful implementation, and potential barriers to change were identified.
resultsTwo thirds of the hospitals in Sweden now have some form of prehospital thrombolysis. A nationally agreed and standardised training programme and the fact that many ambulance paramedics are also qualified nurses has facilitated successful introduction, but Sweden's low population density is also an important factor. Data from Dalarna County indicate that the median "pain to needle" time has been reduced by 45 minutes with a concurrent reduction in complications from 50% to 25% (p=0.018). Inhospital mortality has also reduced from 12% to 6%, but with the small numbers involved this improvement does not achieve statistical significance (p=0.36).
conclusionIf the outcome of acute myocardial infarction in the United Kingdom is to be improved, and National Service Framework targets met, then prehospital thrombolysis is an important development. Several technical solutions already exist, and a single bolus thrombolytic agent is now available, but the main barriers to full implementation are related to the establishment of an effective training programme and the organisational changes that will facilitate this new practice. High quality research is urgently needed to guide the implementation of prehospital thrombolysis in a clinically and cost effective way.
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