Objectives-To 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. Design-Prospective controlled study. Setting-District general hospital CCU and a local district ambulance paramedic service. Patients-124 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 measures-ECG diagnostic accuracy by paramedics, and interval durations for CCU admission and thrombolysis.Results-ECG 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. Conclusions-Trained 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.
Continuous intra-arterial blood pressure recordings during motor car driving were performed in 15 patients with untreated essential hypertension, using the "Oxford" recording technique. Each subject was an experienced driver who used his car every day, and for the study drove from his work place to the hospital during the later afternoon. This drive took place in urban traffic and the average duration was 20.9 minutes. Blood pressure during car driving was remarkably stable, and the average systolic and diastolic pressures were similar to the mean daytime pressure. After 16 weeks of treatment with oxprenolol each patient was restudied. Blood pressure during driving had dropped from 176/107 to 160/93 mmHg, but the blood pressure response to driving and blood pressure variation during driving (expressed as the coefficient of variation) were unchanged. After treatment, the mean daytime systolic pressure was lower than the mean pressure during driving, but the relative antihypertensive effect during driving was similar to that observed in the same patients during dynamic exercise on a bicycle ergometer. No drug-induced side effects occurred and there were no apparent effects on driving ability. Chronic treatment with oxprenolol reduced blood pressure during car driving without affecting the normal blood pressure response to driving.
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