Heart 1997;78:456-461 ( November )

Reduction in treatment delay by paramedic ECG diagnosis of myocardial infarction with direct CCU admission

M W Millar-Craig,^a A V Joy,^a M Adamowicz,^b R Furber,^c B Thomas^d

^a Department of Cardiology, Derbyshire Royal Infirmary NHS Trust, Derby, ^b Coronary Care Unit, ^c FASI, Corporate Planning, Derbyshire Ambulance Service Trust, Kingsway, Derby, ^d IHSM, Training Support

Correspondence to: Dr M W Millar-Craig, Department of Cardiology, Derbyshire Royal Infirmary NHS Trust, London Road, Derby DE1 2QY, UK.

Accepted for publication 4 July 1997

ObjectivesTo establish the feasibility of training paramedics to diagnose acute myocardial infarction by ECG before hospital admission and whether direct paramedic coronary care admission, arranged by very high frequency (VHF) radio communication with the coronary care unit (CCU), would reduce delay of thrombolysis treatment.
DesignProspective controlled study.
SettingDistrict general hospital CCU and a local district ambulance paramedic service.
Patients124 patients with ECG evidence of myocardial infarction or ischaemia admitted directly to the CCU by the paramedic service were compared with 123 patients admitted by the emergency department and subsequently transferred to the CCU.
Main outcome measuresECG diagnostic accuracy by paramedics, and interval durations for CCU admission and thrombolysis.
ResultsECG diagnostic accuracy by the paramedics was 87.5% in the training phase and 92% in admission. The total call to thrombolysis interval was reduced from 154 to 93 minutes and the "door to needle" interval was reduced from 97 to 37 minutes.
ConclusionsTrained paramedics can reliably diagnose myocardial infarction by ECG. The use of a direct admission procedure, by a VHF radio link to the CCU, substantially reduces the time interval for thrombolytic treatment after acute myocardial infarction.

Keywords: myocardial infarction;  electrocardiogram;  thrombolysis;  paramedic

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© 1997 by Heart
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