Prehospital thrombolysis: An idea whose time has come

Aggressive reperfusion therapy for myocardial infarction (MI) characterized by acute ST-segment elevation leads to improved patient outcome. Furthermo re, use of thrombolytic therapy is highly time-dependent: reperfusion thera py is beneficial within 12 h, but the earlier it is administered, the more beneficial it is. Thus, the focus of both prehospital and emergency departm ent management of patients with acute MI is on rapid identification and tre atment. There are many components to the time delays between the onset of s ymptoms of acute MI and the achievement of reperfusion in the occluded infa rct-related artery. Time delays occur with both the patient and the prehosp ital emergency medical system, although patient delays are more significant . This article focuses on the prehospital management of acute MI, including (1) the rationale for rapid reperfusion in patients with acute MI, (2) the factors related to time delays in patient presentation to the hospital, an d (3) strategies for reducing time delays, both patient- and medical system -based.