PRE-HOSPITAL THROMBOLYSIS IN SWEDEN 2000 85 EMERGENCY HOSPITALS 65 ECG-TRANSMISSION 38 PRE-HOSPITAL THROMBOLYSIS 37 RETEPLAS 1 ALTEPLAS or RETEPLAS NATIONAL DATABASE
Dec 29, 2015
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