Pre-hospital Thrombolysis A View from the Front Line Lancashire Ambulance Service NHS Trust Paul Bastow MA SRPara Clinical Effectiveness Manager

Treatment Flow ?2001 Chest painCall for Help 999On sceneLeave A&E CCU Thrombolysis Pain to CallCall to Needle Pain to Needle Scene NHS

Focus Groups Consisting of: Discussion on Paramedic 3 year Re- qualification courses Group work with Clinical paramedic Tutors Discussion with staff in Local CCU’s and A & E departments NHS

Identified Concerns Turfism Litigation Increased time on scene Will the receiving department always action the transmitted ECG’s Debriefing in the case of an adverse reaction NHS

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

“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

How Do We Achieve This? Give staff the evidence Commitment from the Trust’s involved Phased introduction Confidence in the system Involvement of everybody at all stages NHS

The TEAM Approach Training Evaluation Access to Outcomes Medical Partnership NHS

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

Pre-hospital Thrombolysis A View from the Front Line Lancashire Ambulance Service NHS Trust Paul Bastow MA SRPara Clinical Effectiveness Manager