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Limited benefits of ambulance telemetry in delivering early thrombolysis: a randomised controlled trial
- Source :
- Emergency Medicine Journal. 22:209-215
- Publication Year :
- 2005
- Publisher :
- BMJ, 2005.
-
Abstract
- To evaluate the potential of a continuous telemetry system linking rural ambulances to a coronary care unit to reduce call to thrombolysis times.This prospective randomised controlled trial recruited patients using the 999 ambulance service in a rural area of the UK with signs or symptoms of coronary heart disease. Subjects were assigned to receive either standard paramedic treatment or transmission of 12 lead ECG, blood pressure, pulse oximetry, and relevant medical history to a general hospital coronary care unit. Cardiology senior house officers then determined each patient's suitability for pre-hospital thrombolysis time, and transmitted this decision back to the ambulance. This was documented as the potential thrombolysis, although no thrombolytic agents were administered by paramedics. The between groups difference in time to potential thrombolysis (intervention group) and actual thrombolysis (controls) was compared. The proportion of intervention group subjects ultimately receiving thrombolysis in hospital was compared with that recommended for pre-hospital thrombolysis.The potential reduction in call to treatment time for telemetry patients recommended for pre-hospital thrombolysis was 55 minutes (p = 0.022). Following hospital admission,21/213 of the telemetry patients were thrombolysed (10%, 95% confidence interval (CI) 6% to 15%). Of these patients, 3/21 received a recommendation for thrombolysis in the ambulance (14%, 95% CI 3.1% to 36.3%). The sensitivity and specificity of the telemetry system in detecting patients requiring thrombolysis was 13.6 and 99.5% respectively. Errors were made in the pre-hospital treatment recommendations for two patients.Continuous telemetry systems may significantly reduce call to treatment times for patients recommended for pre-hospital thrombolysis in a rural setting. However, this benefit must be balanced against the very small proportion of eligible patients identified as suitable for pre-hospital thrombolysis. This limitation may be due to communications problems, the criteria used to identify eligible patients, or the seniority of physicians tasked with making treatment decisions.
- Subjects :
- Male
medicine.medical_specialty
medicine.medical_treatment
Ambulances
Myocardial Infarction
Critical Care and Intensive Care Medicine
Sensitivity and Specificity
law.invention
Electrocardiography
Randomized controlled trial
law
Humans
Telemetry
Medicine
Thrombolytic Therapy
Medical history
Prospective Studies
Myocardial infarction
Prospective cohort study
Stroke
Aged
Aged, 80 and over
business.industry
Remote Consultation
Coronary Care Units
General Medicine
Thrombolysis
Middle Aged
medicine.disease
Clinical trial
England
Emergency medicine
Emergency Medicine
Physical therapy
Coronary care unit
Prehospital Care
Female
Rural Health Services
business
Subjects
Details
- ISSN :
- 14720213 and 14720205
- Volume :
- 22
- Database :
- OpenAIRE
- Journal :
- Emergency Medicine Journal
- Accession number :
- edsair.doi.dedup.....185fa5a87654193c156670c8e9b52b50