1. PRE-HOSPITAL THROMBOLYSIS IN SWEDEN 2000 85 EMERGENCY HOSPITALS 65 ECG-TRANSMISSION 38 PRE-HOSPITAL THROMBOLYSIS 37 RETEPLAS 1 ALTEPLAS or RETEPLAS NATIONAL DATABASE

2. AMBULANCE SERVICES DALECARLIA YEAR 2000 NUMBER OF EMERGENCY HOSPITALS-decreasing number of transport. -increasing longer distances number of critically ill (ICU-pat.) -increasing

3. AMBULANCE SERVICES DALECARLIA YEAR 2000 DEMANDS NUMBER OF AMBULANCES-increasing DIFFERENT VEHICLES COMPETENCE TELEMEDICINE,GPS HELICOPTERS

4. AMBULANCE SERVICES DALECARLIA 32 VEHICLES 16 - ”24-HOURS” 6 - ”DAILY” 10 - ”RESERVE” 220 EMPLOYEES ”PARAMEDICS” OR ”NURSES” ”DOCTORS” (ANESTH./CARDIOL.)

5. AMBULANCE SERVICES DALECARLIA EMERGENCY HOSPITALS EMERGENCY DEP AT ”CENTRAL HOSPITAL IN FALUN” AMBULANCES SOS-CENTRAL CBD MEDICAL-ADVICE

6. AMBULANCE SERVICES DALECARLIA PREPAREDNESS 90 % WITHIN 30 MINUTES CBD GPS NUMBER OF VEHICLES

7. TELEMEDICINE MEDIUM NMT GSM MOBITEX ( TETRA )

8. CONTAINER AMBULANCE LOADING CAPACITY BATTERY CAPACITY GENERATOR CAPACITY MEDICAL GAS CAPACITY ”ICU-EQUIPMENT” WORKING ENVIRONMENT COMFORT SAFETY ACCESSIBILITY ( 4WD)

9. TELEMEDICINE EQUIPMENT: ¤ STATIONARY/MOBILE ¤ 2 WAY COMMUNIKATION ¤ OTHER PARAMETERS THAN 12-LEAD ECG ¤ COMPATIBILYTY REGIONAL HOSPITALS ICU-MONITORS DIGITAL JOURNALS

10. EDUCATION NURSES A & E CCU/ICU PRIMARY CARE AMBULANCE DOCTORS SOS-CENTRAL 600 PERSONS

11. EDUCATION AMBULANCE 1ST DAY PATOPHYSIOLOGY TIMEASPECTS ECG TREATMENT THROMBOLYSIS/PCI EQUIPMENT MOBIMED/GPS

12. EDUCATION AMBULANCE 2ND DAYHOMESTATION REHEARSAL TRAINING EXAMINATION TOTAL10 HOURS

13. AMI in DALARNA 395/100.000./YEAR 1100 AMI /YEAR (282.OOO INHIBITANTS) 500-550 AMI/YEAR at THE CENTRAL HOSPITAL in FALUN

14. AMI in DALARNA

15. AMI in FALUN 1999

16. CALL-TO-NEEDLE TIME in AMBULANCE MEDIAN43 MIN CALL-ARRIVAL 8 ARRIVAL-ECG 16 ECG-THROMBOLYSIS 19

17. SYMPTOM-TO –NEEDLE TIME YEARHOURS:MIN(MEDIAN) 19973 : 40 19982 : 50 19992 : 30

18. Patient fall I. 47-year female Call 14:05 Pulse 40/min Bp 70 syst. ECG 14:31 Case 1

19. Patient fall I. Thrombolys 14:36 Call to needle time 31 min. Symptom to thrombolys 36 min. Case1

20. CASE 2 45 YEAR FEMALE PAIN9:30 CALL9:35 AMB.ARR.9:50 ECG ( INFERIOR INFARCT.) 10:05 LAB.ARR. 10:30 OPEN VESSEL 10:40

21. CASE 2 PRIMARY PTCA

23. MISTAKE PERICARDITIS CHOLECYSTITIS (with LBBB) AORTICDISSEKTION(THORAX)

24. Pre-hospital thrombolysis 1998-1999 N=78 MORTALITY PREHOSPITAL0 MORTALITY CCU/WARD4 MORTALITY 30 DAYS6

25. CONCLUSIONS EARLY DIAGNOSIS FAST TRACK to CCU/PCI PRE-HOSPITAL TREATMENT of AMI