ArticleBMJ (Clinical research ed.)2003
Prospective observational cohort study of time saved by prehospital thrombolysis for ST elevation myocardial infarction delivered by paramedics.
Article in BMJ (Clinical research ed.), 2003. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers.
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Who cites it
21 citing papers in PubMed, 99 citations in OpenAlex.
- Limited benefits of ambulance telemetry in delivering early thrombolysis: a randomised controlled trial.Emergency medicine journal : EMJ · 2005Trial
- Temporal improvements in prehospital systems-of-care for ST-elevation myocardial infarction patients in Victoria, Australia: a retrospective study.BMC emergency medicine · 2026Article
- Impact of regional STEMI network on rural-urban inequality of ischemic times in Southwest China: a real world longitudinal cohort study : Names of Authors.BMC public health · 2026Article
- Clinical Research in Prehospital Care: Current and Future Challenges.Clinics and practice · 2023Review
- Article
- Time-To-Treatment of Acute Coronary Syndrome and Unit of First Contact in the ERICO Study.Arquivos brasileiros de cardiologia · 2016Observational
- Recent advances in the diagnosis and treatment of acute myocardial infarction.World journal of cardiology · 2015Review
- Paramedics beliefs and attitudes towards pre-hospital thrombolysis.International journal of applied & basic medical research · 2014Article
- Impact on mortality following first acute myocardial infarction of distance between home and hospital: cohort study.Heart (British Cardiac Society) · 2008Article
- Retrospective observational case-control study comparing prehospital thrombolytic therapy for ST-elevation myocardial infarction with in-hospital thrombolytic therapy for patients from same area.Emergency medicine journal : EMJ · 2005Article
- A managed clinical network for cardiac services: set-up, operation and impact on patient care.International journal of integrated care · 2005Article
- Impact of "dual response" on prehospital thrombolysis in remote and rural areas of Scotland: prospective observational study.Emergency medicine journal : EMJ · 2004Article
- Thrombolytic therapy for myocardial infarction facilitated by mobile coronary care.The Ulster medical journal · 2004Article
- Emergency department thrombolysis improves door to needle times.Emergency medicine journal : EMJ · 2004Article
- Improving care for patients with acute coronary syndromes: initial results from the National Audit of Myocardial Infarction Project (MINAP).Heart (British Cardiac Society) · 2004Article
- Prehospital thrombolysis--calculated health benefit for catchment population of one hospital.Journal of the Royal Society of Medicine · 2004Article
- The ABC of community emergency care: Introduction, series summary, the system of care.Emergency medicine journal : EMJ · 2004Article
- Primary Angioplasty for the Treatment of Acute ST-Segment Elevated Myocardial Infarction: An Evidence-Based Analysis.Ontario health technology assessment series · 2004Article
- Costs and effectiveness of prehospital thrombolysis need to be clear.BMJ (Clinical research ed.) · 2003Article
- Prehospital thrombolysis.BMJ (Clinical research ed.) · 2003Article
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Authors and funding
9 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo evaluate a system of prehospital thrombolysis, delivered by paramedics, in meeting the national service framework's targets for the management of acute myocardial infarction.
designProspective observational cohort study comparing patients with suspected acute myocardial infarction considered for thrombolysis in the prehospital environment with patients treated in hospital.
settingThe catchment area of a large teaching hospital, including urban and rural areas.
participants201 patients presenting concurrently over a 12 month period who had changes to the electrocardiogram that were diagnostic of acute myocardial infarction or who received thrombolysis for suspected acute myocardial infarction.
main outcome measuresTime from first medical contact to initiation of thrombolysis (call to needle time), number of patients given thrombolysis appropriately, and all cause mortality in hospital.
resultsThe median call to needle time for patients treated before arriving in hospital (n=28) was 52 (95% confidence interval 41 to 62) minutes. Patients from similar rural areas who were treated in hospital (n=43) had a median time of 125 (104 to 140) minutes. This represents a median time saved of 73 minutes (P < 0.001). Sixty minutes after medical contact 64% of patients (18/28) treated before arrival in hospital had received thrombolysis; this compares with 4% of patients (2/43) in a cohort from similar areas. Median call to needle time for patients from urban areas (n=107) was 80 (78 to 93) minutes. Myocardial infarction was confirmed in 89% of patients (25/28) who had received prehospital thrombolysis; this compares with 92% (138/150) in the two groups of patients receiving thrombolysis in hospital.
conclusionsThrombolysis delivered by paramedics with support from the base hospital can meet the national targets for early thrombolysis. The system has been shown to work well and can be introduced without delay.
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