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PRE-HOSPITAL THROMBOLYSIS IN SWEDEN 2000

PRE-HOSPITAL THROMBOLYSIS IN 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

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PRE-HOSPITAL THROMBOLYSIS IN SWEDEN 2000

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  1. PRE-HOSPITAL THROMBOLYSISINSWEDEN 2000 85 EMERGENCY HOSPITALS 65 ECG-TRANSMISSION 38 PRE-HOSPITAL THROMBOLYSIS 37 RETEPLAS 1 ALTEPLAS or RETEPLAS NATIONAL DATABASE

  2. AMBULANCE SERVICES DALECARLIA YEAR 2000 NUMBER OF EMERGENCY HOSPITALS-decreasing number of transport. -increasing longer distances number of critically ill (ICU-pat.) -increasing

  3. AMBULANCE SERVICESDALECARLIA YEAR 2000 DEMANDS NUMBER OF AMBULANCES-increasing DIFFERENT VEHICLES COMPETENCE TELEMEDICINE,GPS HELICOPTERS

  4. AMBULANCE SERVICESDALECARLIA 32 VEHICLES 16 - ”24-HOURS” 6 - ”DAILY” 10 - ”RESERVE” 220 EMPLOYEES ”PARAMEDICS” OR ”NURSES” ”DOCTORS” (ANESTH./CARDIOL.)

  5. AMBULANCE SERVICESDALECARLIA EMERGENCY HOSPITALS EMERGENCY DEP AT ”CENTRAL HOSPITAL IN FALUN” AMBULANCES SOS-CENTRAL CBD MEDICAL-ADVICE

  6. AMBULANCE SERVICESDALECARLIA PREPAREDNESS 90 % WITHIN 30 MINUTES CBD GPS NUMBER OF VEHICLES

  7. TELEMEDICINE MEDIUM NMT GSM MOBITEX ( TETRA )

  8. CONTAINER AMBULANCE LOADING CAPACITY BATTERY CAPACITY GENERATOR CAPACITY MEDICAL GAS CAPACITY ”ICU-EQUIPMENT” WORKING ENVIRONMENT COMFORT SAFETY ACCESSIBILITY ( 4WD)

  9. TELEMEDICINE EQUIPMENT: ¤ STATIONARY/MOBILE ¤ 2 WAY COMMUNIKATION ¤ OTHER PARAMETERS THAN 12-LEAD ECG ¤ COMPATIBILYTY REGIONAL HOSPITALS ICU-MONITORS DIGITAL JOURNALS

  10. EDUCATION NURSES A & E CCU/ICU PRIMARY CARE AMBULANCE DOCTORS SOS-CENTRAL 600 PERSONS

  11. EDUCATIONAMBULANCE 1ST DAY PATOPHYSIOLOGY TIMEASPECTS ECG TREATMENT THROMBOLYSIS/PCI EQUIPMENT MOBIMED/GPS

  12. EDUCATIONAMBULANCE 2ND DAY HOMESTATION REHEARSAL TRAINING EXAMINATION TOTAL 10 HOURS

  13. AMI in DALARNA 395/100.000./YEAR 1100 AMI /YEAR (282.OOO INHIBITANTS) 500-550 AMI/YEAR at THE CENTRAL HOSPITAL in FALUN

  14. AMI in DALARNA

  15. AMI in FALUN 1999

  16. CALL-TO-NEEDLE TIME in AMBULANCE MEDIAN 43 MIN CALL-ARRIVAL 8 ARRIVAL-ECG 16 ECG-THROMBOLYSIS 19

  17. SYMPTOM-TO –NEEDLE TIME YEAR HOURS:MIN(MEDIAN) 1997 3 : 40 1998 2 : 50 1999 2 : 30

  18. Patient fall I. 47-year female Call 14:05 Pulse 40/min Bp 70 syst. ECG 14:31 Case 1

  19. Thrombolys 14:36 Call to needle time 31 min. Symptom to thrombolys 36 min. Patient fall I. Case1

  20. 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

  21. CASE 2PRIMARY PTCA OCCLUSION

  22. CASE 2PRIMARY PTCA OPEN OPEN

  23. MISTAKE PERICARDITIS CHOLECYSTITIS (with LBBB) AORTICDISSEKTION(THORAX)

  24. Pre-hospital thrombolysis1998-1999 N=78 MORTALITY PREHOSPITAL 0 MORTALITY CCU/WARD 4 MORTALITY 30 DAYS 6

  25. CONCLUSIONS EARLY DIAGNOSIS FAST TRACK to CCU/PCI PRE-HOSPITAL TREATMENT of AMI

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