Prehospital Thrombolysis A View from the Front Line

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Pre-hospital ThrombolysisA View from the Front
Line
Lancashire Ambulance Service
NHS Trust
Paul Bastow MA SRPara Clinical Effectiveness
Manager
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Treatment Flow ?2001
Thrombolysis
AE
Chest pain
Call for Help
999
On scene
Leave
CCU
Scene
Pain to Call
Call to Needle
Pain to Needle
NHS
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Focus Groups

• Consisting of
• Discussion on Paramedic 3 year Re-qualification
  courses
• Group work with Clinical paramedic Tutors
• Discussion with staff in Local CCUs and A E
  departments

NHS
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Identified Concerns

• Turfism
• Litigation
• Increased time on scene
• Will the receiving department always action the
  transmitted ECGs
• Debriefing in the case of an adverse reaction

NHS
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Identified Benefits

• Better relationship between pre-hospital
  secondary care
• Patient receives treatment earlier
• Increase our effectiveness
• Will give the paramedic a higher professional
  profile
• Increases patient life expectancy

NHS
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A pre-hospital paramedic programme for
identifying and treating thrombolysis-eligible
patients requires intensive planning,
retrospective feasibility work, implementation
and monitoring to establish effectiveness
Myers RBH Can J Cardiology 1998
NHS
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How Do We Achieve This?

• Give staff the evidence
• Commitment from the Trusts involved
• Phased introduction
• Confidence in the system
• Involvement of everybody at all stages

NHS
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The TEAM Approach

• Training
• Evaluation
• Access to Outcomes
• Medical Partnership

NHS
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The TEAM Approach
By using the TEAM approach we can achieve
Seamless Integrated Patient Care where Joint
decision making takes place and all players are
fully involved.
NHS
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Pre-hospital ThrombolysisA View from the Front
Line
Lancashire Ambulance Service
NHS Trust
Paul Bastow MA SRPara Clinical Effectiveness
Manager