Pitt K
Welsh Ambulance Services NHS Trust, UK.
Emerg Med J. 2002 May;19(3):260-3. doi: 10.1136/emj.19.3.260.
Heart disease is the major cause of death in Wales. Myocardial infarction accounts for most fatalities either acutely or as a result of late heart failure and unheralded sudden cardiac death. Prompt relief of new coronary occlusions by thrombolytic agents has been shown to reduce significantly both early mortality and subsequent morbidity from acute myocardial infarction. The prehospital delivery of these drugs is feasible, and carries no greater risk than administration in hospital. This study tests the hypothesis that paramedics can identify patients with acute myocardial infarction who are suitable for prehospital thrombolysis, and thus reduce the "call to needle" time.
Paramedics from rural Wales were trained in the acquisition and recognition of 12 lead ECGs, and also in the modified indications for thrombolytic therapy as defined by the Joint Royal Colleges Ambulance Liaison Committee (JRCALC). Ninety six consecutive patients, with possible myocardial infarction, were included in the study. The paramedics made an independent decision regarding the eligibility of the patients for thrombolysis before hospital admission, noting the time that they could have administered the drug. These decisions were compared with the treatment subsequently received in hospital.
No errors were made by the paramedics in case selection (specificity of 100% (95% CI 95.9% to 100%)). There was a potential reduction in call to needle time of 41.2 minutes (95% CI 25.7 minutes to 56.9 minutes, p=0.001).
It was concluded that the paramedic selection of patients for the prehospital administration of a thrombolytic is both feasible and safe.
心脏病是威尔士的主要死因。心肌梗死是大多数急性死亡以及晚期心力衰竭和隐匿性心源性猝死的原因。溶栓药物能迅速解除新的冠状动脉阻塞，已被证明可显著降低急性心肌梗死的早期死亡率和随后的发病率。这些药物在院前给药是可行的，且风险不高于在医院给药。本研究检验以下假设：护理人员能够识别适合院前溶栓的急性心肌梗死患者，从而缩短“呼叫至用药”时间。
来自威尔士农村的护理人员接受了12导联心电图采集和识别方面的培训，以及由皇家联合学院救护联络委员会（JRCALC）定义的溶栓治疗修改指征方面的培训。96例可能发生心肌梗死的连续患者被纳入研究。护理人员在患者入院前就其是否适合溶栓做出独立决定，并记录他们可以给药的时间。将这些决定与患者随后在医院接受的治疗进行比较。
护理人员在病例选择上没有出现错误（特异性为100%（95%可信区间为95.9%至100%））。“呼叫至用药”时间可能缩短41.2分钟（95%可信区间为25.7分钟至56.9分钟，p = 0.001）。
得出的结论是，护理人员选择患者进行院前溶栓给药既可行又安全。
