PRE-HOSPITAL THROMBOLYSIS IN SWEDEN 2000

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PRE-HOSPITAL THROMBOLYSISINSWEDEN 2000
85 EMERGENCY HOSPITALS 65 ECG-TRANSMISSION 38
PRE-HOSPITAL THROMBOLYSIS 37 RETEPLAS 1
ALTEPLAS or RETEPLAS NATIONAL DATABASE
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AMBULANCE SERVICES DALECARLIA
YEAR 2000 NUMBER OF EMERGENCY HOSPITALS-decreasin
g number of transport. -increasing longer
distances number of critically ill (ICU-pat.)
-increasing
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AMBULANCE SERVICESDALECARLIA
YEAR 2000 DEMANDS NUMBER OF AMBULANCES-increasin
g DIFFERENT VEHICLES COMPETENCE TELEMEDICINE
,GPS HELICOPTERS
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AMBULANCE SERVICESDALECARLIA
32 VEHICLES 16 - 24-HOURS 6 - DAILY 10
- RESERVE 220 EMPLOYEES PARAMEDICS OR
NURSES DOCTORS (ANESTH./CARDIOL.)
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AMBULANCE SERVICESDALECARLIA
EMERGENCY HOSPITALS EMERGENCY DEP AT CENTRAL
HOSPITAL IN FALUN AMBULANCES SOS-CENTRAL C
BD MEDICAL-ADVICE
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AMBULANCE SERVICESDALECARLIA
PREPAREDNESS 90 WITHIN 30 MINUTES CBD GPS NUM
BER OF VEHICLES
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TELEMEDICINE
MEDIUM NMT GSM MOBITEX ( TETRA )
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CONTAINER AMBULANCE

LOADING CAPACITY BATTERY CAPACITY GENERATOR
CAPACITY MEDICAL GAS CAPACITY ICU-EQUIPMENT WORK
ING ENVIRONMENT COMFORT SAFETY ACCESSIBILITY (
4WD)
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TELEMEDICINE
EQUIPMENT STATIONARY/MOBILE 2 WAY
COMMUNIKATION OTHER PARAMETERS THAN 12-LEAD
ECG COMPATIBILYTY REGIONAL
HOSPITALS ICU-MONITORS DIGITAL JOURNALS
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EDUCATION
NURSES A E CCU/ICU PRIMARY
CARE AMBULANCE DOCTORS SOS-CENTRAL 600
PERSONS
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EDUCATIONAMBULANCE
1ST DAY PATOPHYSIOLOGY TIMEASPECTS ECG
TREATMENT THROMBOLYSIS/PCI EQUIPMENT
MOBIMED/GPS
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EDUCATIONAMBULANCE
2ND DAY HOMESTATION REHEARSAL TRAINING
EXAMINATION TOTAL 10 HOURS
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AMI in DALARNA
395/100.000./YEAR 1100 AMI /YEAR (282.OOO
INHIBITANTS) 500-550 AMI/YEAR at THE CENTRAL
HOSPITAL in FALUN
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AMI in DALARNA
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AMI in FALUN 1999
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CALL-TO-NEEDLE TIME in AMBULANCE
MEDIAN 43 MIN CALL-ARRIVAL
8 ARRIVAL-ECG 16 ECG-THROMBOLYSIS 19
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SYMPTOM-TO NEEDLE TIME
YEAR HOURSMIN(MEDIAN) 1997 3
40 1998 2 50 1999 2 30
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Patient fall I.

Case 1

• 47-year female
• Call 1405
• Pulse 40/min
• Bp 70 syst.
• ECG 1431

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Patient fall I.
Case1

• Thrombolys 1436
• Call to needle time 31 min.
• Symptom to thrombolys 36 min.

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CASE 245 YEAR FEMALE

• PAIN 930
• CALL 935
• AMB.ARR. 950
• ECG (INFERIOR INFARCT.) 1005
• LAB.ARR. 1030
• OPEN VESSEL 1040

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CASE 2PRIMARY PTCA
OCCLUSION
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CASE 2PRIMARY PTCA
OPEN
OPEN
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MISTAKE
PERICARDITIS CHOLECYSTITIS (with
LBBB) AORTICDISSEKTION(THORAX)
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Pre-hospital thrombolysis1998-1999
N78 MORTALITY PREHOSPITAL 0 MORTALITY
CCU/WARD 4 MORTALITY 30 DAYS 6
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CONCLUSIONS
EARLY DIAGNOSIS FAST TRACK to CCU/PCI PRE-HOSPITAL
TREATMENT of AMI