PRE-HOSPITAL THROMBOLYSISIN

SWEDEN 2000

85 EMERGENCY HOSPITALS

65 ECG-TRANSMISSION

38 PRE-HOSPITAL THROMBOLYSIS

37 RETEPLAS

1 ALTEPLAS or RETEPLAS

NATIONAL DATABASE

AMBULANCE SERVICES DALECARLIA

YEAR 2000

NUMBER OF EMERGENCY HOSPITALS-decreasing

number of transport. -increasing

longer distances

number of critically ill (ICU-pat.) -increasing

AMBULANCE SERVICESDALECARLIA

YEAR 2000

DEMANDS

NUMBER OF AMBULANCES-increasing

DIFFERENT VEHICLES

COMPETENCE

TELEMEDICINE,GPS

HELICOPTERS

AMBULANCE SERVICESDALECARLIA

32 VEHICLES

16 - ”24-HOURS”

6 - ”DAILY”

10 - ”RESERVE”

220 EMPLOYEES

”PARAMEDICS” OR ”NURSES”

”DOCTORS” (ANESTH./CARDIOL.)

AMBULANCE SERVICESDALECARLIA

EMERGENCY HOSPITALS

EMERGENCY DEP AT ”CENTRAL HOSPITAL IN FALUN”

AMBULANCES

SOS-CENTRAL

CBD

MEDICAL-ADVICE

AMBULANCE SERVICESDALECARLIA

PREPAREDNESS

90 % WITHIN 30 MINUTES

CBD

GPS

NUMBER OF VEHICLES

TELEMEDICINE

MEDIUM

NMT

GSM

MOBITEX

( TETRA )

CONTAINER AMBULANCELOADING CAPACITY

BATTERY CAPACITY

GENERATOR CAPACITY

MEDICAL GAS CAPACITY

”ICU-EQUIPMENT”

WORKING ENVIRONMENT

COMFORT

SAFETY

ACCESSIBILITY ( 4WD)

TELEMEDICINE

EQUIPMENT:

¤ STATIONARY/MOBILE ¤ 2 WAY COMMUNIKATION ¤ OTHER PARAMETERS THAN 12-LEAD ECG ¤ COMPATIBILYTY

REGIONAL HOSPITALSICU-MONITORSDIGITAL JOURNALS

EDUCATION

NURSES

A & ECCU/ICUPRIMARY CARE

AMBULANCE

DOCTORS

SOS-CENTRAL

600 PERSONS

EDUCATIONAMBULANCE

1ST DAY

PATOPHYSIOLOGY

TIMEASPECTS

ECG

TREATMENT

THROMBOLYSIS/PCI

EQUIPMENT

MOBIMED/GPS

EDUCATIONAMBULANCE

2ND DAY HOMESTATION

REHEARSAL

TRAINING

EXAMINATION

TOTAL 10 HOURS

AMI in DALARNA

395/100.000./YEAR

1100 AMI /YEAR (282.OOO INHIBITANTS)

500-550 AMI/YEAR at THE CENTRAL HOSPITAL in FALUN

AMI in DALARNA

C C U

T H R O M B O L Y S IS

C C U W A R D /H O M E

A & E

C C U

P C I

C A R D IO L O G IS T

A M B U L A N C E E C G

S O S

C H E S T P A IN

AMI in FALUN 1999

3 66N O N -Q

24P H T1 6%

51P C I3 4%

77T H R -IN D O O R

5 0%

1 52S T -E L E V A T IO N

5 18

CALL-TO-NEEDLE TIME in AMBULANCE

MEDIAN 43 MIN

CALL-ARRIVAL 8

ARRIVAL-ECG 16

ECG-THROMBOLYSIS 19

SYMPTOM-TO –NEEDLE TIME

YEAR HOURS:MIN(MEDIAN)

1997 3 : 40

1998 2 : 50

1999 2 : 30

Patient fall I.

• 47-year female• Call 14:05• Pulse 40/min• Bp 70 syst.• ECG 14:31

Case 1

Patient fall I.

• Thrombolys 14:36• Call to needle time

31 min.• Symptom to

thrombolys 36 min.

Case1

CASE 245 YEAR FEMALE

• PAIN 9:30

• CALL 9:35

• AMB.ARR. 9:50

• ECG (INFERIOR INFARCT.) 10:05

• LAB.ARR. 10:30

• OPEN VESSEL 10:40

CASE 2PRIMARY PTCA

CASE 2PRIMARY PTCA

MISTAKE

PERICARDITIS

CHOLECYSTITIS (with LBBB)

AORTICDISSEKTION(THORAX)

Pre-hospital thrombolysis1998-1999

N=78

MORTALITY PREHOSPITAL 0

MORTALITY CCU/WARD 4

MORTALITY 30 DAYS 6

CONCLUSIONS

EARLY DIAGNOSIS

FAST TRACK to CCU/PCI

PRE-HOSPITAL TREATMENT of AMI