Administering Fibrinolotyics by Paramedics Prior to Hospital Arrival

Street Science


 
 

Keith Wesley | | Monday, June 25, 2007


Review of: Welsh R, Travers A, Senaratne M, et al: "Feasibility and applicability of paramedic-based prehospital fibrinolysis in a large North American center." American Heart Journal. 152(6):1007-1014, 2006

The Science

By now, everyone should be convinced of the value of prehospital 12-leads in identifying the STEMI patient who may benefit from either fibrionolytics or interventional cardiology. The controversy now is what if any potential exists for administering fibrinolotyics by paramedics prior to arrival at the hospital.

This study from Canada had paramedics perform 12-leads and transmit them to a physician who would then review it and go over the patient's history to determine whether or not they were candidates for fibrinolytics. The patient was then randomized to either get the "clot buster" in the field or wait until they arrived at the hospital.

Time to treatment was of course reduced by prehospital administration from 2:38 minutes to 1:43 minutes. There was no difference in complication rates or mortality between the two groups. In fact, patients who received prehospital fibrinolytics had lower peak levels of creatine kinase and Q waves at discharge, meaning that they had less damage to their heart.

Their conclusion was that prehospital is not only feasible but may be beneficial over conventional therapy.

The Street

This is the first large scale study examining the potential role for prehospital fibrinolytic therapy. Clearly, with proper medical oversight and transmission of 12-leads, paramedics can be trained and educated to administer the agents.

However, this study raises some interesting questions that can only be answered by understanding the system. For example, why was the reduction in time to treatment almost an hour? Was transport time an hour longer? Or if not, then why would it take that long for the hospitals to get the agents administered? What would the time to treatment have been if the 12-lead had been transmitted to the receiving facility?

Interestingly, of the 65 patients that were excluded from prehospital fibrinolytic administration, almost half either had a left bundle branch block, inadequate history or were hypertensive. I would like to know how many of those patients subsequently received agents in the hospital.

While this study proves the potential utility for prehospital fibrinolytics, there are many questions that need to be answered to determine whether it makes sense for your system.




Connect: Have a thought or feedback about this? Add your comment now
Related Topics: Cardiac and Circulation, Medical Emergencies, Research

What's Your Take? Comment Now ...

Featured Careers & Jobs in EMS





 

Get JEMS in Your Inbox

 

Fire EMS Blogs


Blogger Browser

Today's Featured Posts

 

EMS Airway Clinic

Simulation-Based Assessment Facilitates Learning & Enhances Clinical Judgment

Simulation is an educational tool that can be used to develop and refine clinical skills of the student in a controlled environment before they progress to becoming practicing clinicians.
More >

Multimedia Thumb

REMSA Programs Helps Reduce Hospital Visits

Community paramedic effort goes into service.
Watch It >


Multimedia Thumb

City Official Challenges San Francisco Fire Chief

Ambulance response times among problems noted by city supervisor.
Watch It >


Multimedia Thumb

Texas Ambulance Crash

Victoria ambulance collides with civilian vehicle.
Watch It >


Multimedia Thumb

Colorado Medics Ditch Pants for Kilts

“Real men do wear kilts.”
Watch It >


Multimedia Thumb

CO Leak at Illinois School

Girard incident sends over 130 to hospitals.
More >


Multimedia Thumb

Hands On September 2014

Who gets thumbs up this month?
More >


Multimedia Thumb

NYC Sept. 11 Anniversary

View images from the ceremony at Ground Zero.
More >


Multimedia Thumb

The AmbuBus®, Bus Stretcher Conversion Kit - EMS Today 2013

AmbuBus®, Bus Stretcher all-hazards preparedness & response tool
Watch It >


Multimedia Thumb

LMA MAD Nasal™

Needle-free intranasal drug delivery.
Watch It >


Multimedia Thumb

Field Bridge Xpress ePCR on iPad, Android, Kindle Fire

Sneak peek of customizable run forms & more.
Watch It >


More Product Videos >