Current state of the art in the management of patients with acute myocardial infarction and ischemia within the Maryland Emergency Medical Service system.

Maryland has a pioneering and sophisticated system of prehospital emergency medical care. Approximately 44,000 patients with chest pain and/or acute myocardial infarction were transported last year by emergency medical service (EMS) providers who also responded to approximately 5,000 out-of-hospital cardiac arrests. Funding has recently been prioritized to enable EMS providers to be trained and equipped with automated external defibrillators. Future consideration may be given to purchasing defibrillators with integrated 12-lead electrocardiographic capability. These devices have been shown to reduce the time required to initiate thrombolytic therapy once in the emergency department. There are presently no data in the United States that support the prehospital administration of thrombolytics.