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Abstract
Because the benefits from thrombolytic therapy in acute myocardial infarction (AMI)
are time dependent, multiple strategies have been devised to speed therapy. This study
sought to determine whether hospital-based nurse and paramedic advanced life support
(ALS) providers could be trained to independently evaluate (sight read) a prehospital
12-lead electrocardiogram (ECG) for the presence of AMI as part of a protocol designed
to speed in-hospital administration of thrombolytic agents. Providers were required
to determine on the basis of a protocol (1) whether or not AMI was present, and (2)
whether or not thrombolytic therapy was indicated. Providers then radioed their impression
to the emergency department (ED) and initiated a protocol to prepare identified candidates
for thrombolysis. The final decision to initiate thrombolytic therapy was made by
the ED physician after patient arrival at the hospital. One hundred fifty-five patients
with chest pain were studied. Twenty-one (13.5%) were ultimately proven in-hospital
to have AMI. Providers were able to recognize AMI in 17 of 21. Four of 21 did not
meet ECG criteria for AMI on the field ECG, but were categorized as having a high
index of suspicion for AMI by providers. There were no false-positive diagnoses. Fourteen
patients (9%) received thrombolytic therapy. In-hospital times to administration of
thrombolytic therapy decreased to an average of 22 ± 13.8 minutes in the studied group
compared with a historical control group average of 51 ± 50 minutes. It is concluded
that hospital-based paramedics and nurses can successfully be taught to evaluate (ie,
sight read) a prehospital ECG for the presence of AMI with accuracy. A prehospital
chest pain protocol using a field ECG can speed in-hospital administration of thrombolytic
therapy to the extent that field administration of thrombolytic agents may not significantly
improve times to administration of therapy when transport times are similar to those
of this study.
Keywords
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Article Info
Publication History
Accepted:
May 28,
1993
Received:
April 2,
1993
Identification
Copyright
© 1994 Published by Elsevier Inc.
