Safety and feasibility of prehospital thrombolysis carried out by paramedics.

The benefits of thrombolysis in patients with acute myocardial infarction are time dependent, with a potential 48% reduction in mortality if treatment is received within an hour of onset of symptoms. The benefits diminish thereafter. However the “call to needle” standard set by the national service framework has been achieved for only a third of patients nationally because of lengthy ambulance journeys and delays in hospital. Prehospital thrombolysis may be the most feasible means of achieving timely reperfusion, and all published studies have shown the accuracy of diagnosis, patient selection, and administration of thrombolysis. The Joint Royal Colleges Ambulance Liaison Committee favours autonomous prehospital thrombolysis by paramedics as a long term objective. We tested the feasibility of physician assisted and autonomousmodels of paramedic prehospital thrombolysis.