Pre-hospital aspirin for suspected myocardial infarction and acute coronary syndromes: A headache for paramedics?

Objective-To ascertain the frequency with which paramedics follow protocols for the administration of aspirin to patients to whom an ambulance is call ed for chest pain associated with suspected ischaemic heart disease. Methods-Ambulance services in England and Wales who had conducted a recent aspirin administration audit were identified through the National Clinical Effectiveness Programme for the Ambulance Service Association. Data were re quested from each of these services with a 100% return rate. Results-Nine services out of a total of 35 had collected appropriate data. The proportion of patients who were given aspirin by a paramedic varied fro m 11% to 74%. The range of proportions of patients receiving pre-hospital a spirin increased after adding those patients who had already received aspir in from an alternative health provider, to 19% to 78%. It is estimated that at least 15% to 74% of patients who should have been given aspirin by the various ambulance services did not receive it. The proportion of patients f or whom aspirin was judged to be inappropriate ranged from 4% to 35%. The r eason for these widely varying and generally poor levels of compliance is n ot known. However, the range of indications and contraindications to the ad ministration of aspirin varied considerably by ambulance service. This also made the comparison of data from different sources difficult. Conclusions-Aspirin has been shown to be beneficial after a myocardial infa rction and for other acute coronary syndromes. However, variances in the pr oportion of patients with suspected ischaemic heart disease given aspirin i n different ambulance services indicates the need for a re-emphasis on the importance of this treatment. A standard protocol for all UK ambulance serv ices should be devised that minimises the number of contraindications to as pirin and otherwise requires its administration to all patients with acute coronary syndromes or suspected myocardial infarction. Regular, standardise d audits of compliance should also be conducted and their results widely di sseminated.