None listed
Conditions
Brief summary
Heart disease is the second leading cause of death in New Zealand, after cancer. At the acute end of the spectrum of this disease is ST-elevation myocardial Infarction (STEMI), a common type of heart attack and the most severe. However, specific treatments are available for STEMI patients, which have high rates of success, especially if they are performed early, within the first hours of symptom onset. One such treatment is ‘thrombolysis’ which involves the administration of certain drugs. This treatment is time-dependent, with early provision conferring the greatest clinical benefits and results. Paramedics are able to play a key strategic role in achieving this objective, as they are often the first healthcare professionals to encounter the STEMI patient. Internationally, autonomous paramedic-delivered pre-hospital thrombolysis (PHT) has proven to be the most effective strategy in facilitating expedited delivery of this treatment modality. However, within New Zealand ambulance services have been slow to adopt and/or refine such paramedic-based approaches. Current New Zealand models rely on physician authorised telemetry-based systems which have proved problematic, particularly due to technological failings. This proposed research will be an experimental study trialling an autonomous paramedic model for PHT within St John Ambulance Service, New Zealand’s largest ambulance provider, without physician oversight and authorisation. We hypothesise that adopting this approach will lead to improved patient outcomes, with reduced hospital admission times compared to the physician-authorised telemetry model. Economic benefits are also likely.
Interventions
This proposed research will be an experimental study trialling an autonomous paramedic model for pre-hospital thrombolysis (PHT) within St John Ambulance Service, New Zealand’s largest ambulance provider, without physician oversight and authorisation. We hypothesise that adopting this approach will lead to improved patient outcomes, with reduced hospital admission times compared to the physician-authorised telemetry model. Economic benefits are also likely.
Paramedics will provide the existing
This proposed research will be an experimental study trialling an autonomous paramedic model for pre-hospital thrombolysis (PHT) within St John Ambulance Service, New Zealand’s largest ambulance provider, without physician oversight and authorisation. We hypothesise that adopting this approach will lead to improved patient outcomes, with reduced hospital admission times compared to the physician-authorised telemetry model. Economic benefits are also likely. Paramedics will provide the existing treatment of PHT following the existing drug regime. The criteria for autonomous paramedic-delivered PHT will include the following: 1. DEFINITE STEMI ONLY: Paramedic and heart monitor interpretation of STEMI (>>> Acute MI <<<) 2. ST elevation greater than or equal to 1mm in two or more limbs leads (I, II, III, aVL or aVF) or 3. ST elevation greater than or equal to 2mm in two or more contiguous chest leads (V1-V6) AND 4. Symptoms consistent with myocardial ischemia of less than 12hrs duration AND 5. Transport time to hospital greater than 15 minutes The existing PHT drug regime that will be utilised includes: *Aspirin 300mg per oral (PO) *Enoxaparin 30mg intravenously (IV) for patients under 75yrs of age only *Tenecteplase IV – dose dependent based on the patient’s weight using the graduations on the syringe *Enoxaparin 1mg/kg subcutaneous based on the patient’s weight using the graduations on the syringe *Clopidogrel 600mg PO for patients under 75yrs of age only. For patients over 75yrs give 300 mg PO. The overall intervention period for this study will be 20 months.
Sponsors
Auckland University of Technology (AUT)
Study design
Allocation
Non-randomised trial
Primary purpose
Treatment
Eligibility
Sex/Gender
All
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
a) The retrospective cohort (n = 54) will include patients at/or greater than 18 years of age who have received paramedic-delivered PHT under physician authorisation in the Northland and Hawkes Bay regions since this historic PHT model was established in 2008. b) The prospective cohort (n = 54) will include; patients at/or greater than 18 years of age who receive autonomous paramedic-delivered PHT; or those who have been considered for the treatment over a 20 month period; in the Northland and Hawkes Bay regions; and in line with protocol criteria. In addition, during this 20-month prospective period, the study will also investigate all patients at/or greater than 18 years of age transported by paramedics without PHT treatment in the same regions, but who went on to receive in-hospital thrombolysis following an in-hospital diagnosis of STEMI.
Exclusion criteria
Key patient exclusion criteria is essentially those that do not meet our inclusion criteria for either the historic or prospective cohort.
Outcome results
None listed