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.
The standards to which UK Paramedics and Emergency Medical Technicians work have historically been driven by the employer rather than a professional body. This in effect has meant that the National Health Service (NHS) Ambulance Services decided how educational programmes were structured and delivered. The private sector in the UK has also tended to look towards the NHS standards as the yardstick for their staff, although there has been significant difficulty in gaining the NHS award by the private sector. The advent of professional registration in 2000, and crucially the enactment of The Health Professions Order 2001 that resulted in the setting up of the Health Professions Council (HPC), prompted a real drive to develop a true professional body for UK ambulance staff. That professional body is the British Paramedic Association – College of Paramedics (BPA). The BPA has, since those early days, pursued true professional self-regulation of education and practice standards. The BPA acknowledges the immense task it has set itself, but believes that it can and must be achieved in order that education and practice standards continue to develop and deliver what is felt to be in the best interests of patients. By engaging with the HPC, the unions, employers and, very importantly, higher education institutions, the BPA will truly fulfill the requirements of a professional body for UK ambulance staff.
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