DELAY TIMES IN THE ADMINISTRATION OF THROMBOLYTIC THERAPY - THE BRIGHTON EXPERIENCE

We reviewed the effectiveness of a strategy involving paramedic ambula nces and community education to reduce the delay to thrombolytic thera py in patients admitted with acute myocardial infarction, by analysing delay times recorded during routine treatment. Rapid identification a nd treatment of patients with acute myocardial infarction who were eli gible for thrombolysis was carried out in the Accident and Emergency a nd Cardiac Care Units. Two hundred seventy-four patients were admitted with acute myocardial infarction over an 18-month period and treated with anistreplase (168) or streptokinase (105). The following median t imes were recorded: symptom onset to administration of thrombolytic th erapy, 142 min (range 43-980 min); symptom onset to ambulance arrival, 60 min; ambulance with patient to arrival in hospital, 35 min; time t o treatment in hospital ('door to needle time'), 25 min; in-hospital d elays were notably shorter for patients given anistreplase as opposed to streptokinase. Shortened delays for the delivery of thrombolytic th erapy can be achieved by a strategy involving public education, the av ailability of resuscitation ambulances, and close liaison with the Acc ident and Emergency Department.