Bridging the Gap Between Primary and Secondary Care

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South Western Ambulance Service NHS Trust
Cardiac Care The Journey Continues
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What is a heart attack?
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Plague ruptures
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Ischemia Injury Necrosis
Every second counts
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South Western Ambulance Service NHS Trust
Thrombolysis
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Thrombolysis
Thrombolytic dissolves clot
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National Service Framework

• Standard Five
• Anyone with symptoms of a possible heart attack
  should receive help from an individual equipped
  with a defibrillator within 8 minutes of calling
  for help.
• Standard Six
• Anyone thought to be suffering from a heart
  attack should be professionally assessed, and
  where appropriate should receive thrombolysis
  within 60 minutes of calling for professional
  help.

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Achievements During 07/08

• England and Wales
• To date, over 10,000 heart attack patients have
  received pre-hospital thrombolysis.
• 3,176 patients received pre-hospital during
  07/08.
• South West
• xx category A calls attended within 8 minutes.
• 556 patients received pre-hospital thrombolysis.
• 70 of patients thrombolysed within 60 minutes.

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Time benefit curve
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South Western Ambulance Service NHS Trust
Primary Angioplasty
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Wire stent being expanded using a balloon
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Angiogram of blocked blood vessel
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Balloon being inflated, expanding stent
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Angiogram of re-opened blood vessel
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Advantages of Primary Angioplasty

• Superior blood vessel flow rates
• Reduced mortality rate
• Reduced risk of a repeat heart attack
• Reduced risk of stroke
• Shorter length of stay in hospital
• Allows reperfusion when thrombolysis is
  contraindicated

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Geographical Challenges
Royal Bournemouth Hospital
15 Minute Drivetime
30 Minute Drivetime
45 Minute Drivetime
60 Minute Drivetime
75 Minute Drivetime
90 Minute Drivetime
105 Minute Drivetime
120 Minute Drivetime
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South Western Ambulance Service NHS Trust
Ambulance Response
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Call prioritised at category A using AMPDS
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Nearest ambulance resource dispatched
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Nearest Paramedic dispatched
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Specialist assessment
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Rapid decision thrombolysis vs primary
angioplasty
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South Western Ambulance Service NHS Trust
2008 - 2009 Planned Developments
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Increased availability of primary angioplasty
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European LUCAS study to commence
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Significant investment in new defibrillators
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South Western Ambulance Service NHS Trust
Responding quickly and safely...
to save lives, to minimize anxiety, pain and
suffering