What are the beliefs and attitudes of paramedics to prehospital thrombolysis? A questionnaire study

Paramedics beliefs and attitudes towards pre-hospital thrombolysis

Background:

Myocardial infarction is the third leading cause of death in the developing countries. Thrombolysis as a reperfusion therapy is shown to have a great role in decreasing mortality. The efficacy of thrombolytic therapy lies in its ability to reduce the duration of occlusion by early administration. Many of the studies have supported pre-hospital thrombolysis (PHT) therapy and proven that it is beneficial in acute myocardial infarction (AMI) patients.

Methodology:

Questionnaires adopted from studies of Humphrey et al., were distributed to paramedics in Saudi Red Crescent Authority and Emergency Medical Services Departments at King Abdulaziz Medical City, King Fahad Medical City, Prince Sultan Medical Military City and Security Forces Hospital in Riyadh. A total of 7 questions were about the knowledge of risk and benefit of PHT and 12 questions were about the beliefs and attitudes of paramedics toward PHT in AMI patients.

Results:

The response rate was 87%. Nearly 72% were believed to be capable of performing PHT, 87% are confident about recording 12-lead electrocardiogram in pre-hospital settings and 77% are confident in the interpretation. 94% believe that PHT will have a significant impact on pain to needle time. 77% consider PHT to be safe for use by paramedics. 66% preferred on-line medical direction or telemedicine linked with the supervision of a physician. Regarding the knowledge part, majority gave a correct answer, but the major concern was that 43% of the paramedics overestimated direct relation of bleeding to thrombolysis therapy.

Conclusion:

Majority of paramedics in Riyadh support the principle of PHT in patients with AMI via online medical direction. They believe that they are confident in their ability to administer PHT despite the concern of authorities on their level of training, the related risks and medico-legal issues. Nevertheless, since the total duration of PHT course for paramedics is just 2 days, we consider that the procedure should be performed under expert supervision until they achieve expertise.

Evaluating the views of paramedics, cardiologists, emergency department physicians and nurses on advanced prehospital management of acute ST elevation myocardial infarction

BACKGROUND

Although advanced prehospital management (PHM) in ST elevation myocardial infarction (STEMI) reduces reperfusion delay and improves patient outcomes, its use in North America remains uncommon. Understanding perceived barriers to and facilitators of PHM implementation may support the expansion of programs, with associated patient benefit.

OBJECTIVE

To explore the attitudes and beliefs of paramedics, cardiologists, emergency physicians and nurses regarding these issues.

METHODS

To maximize the potential to identify unpredictable issues within each of the four groups, focus group sessions were recorded, transcribed and analyzed for themes using the constant comparative method.

RESULTS

All 18 participants believed that PHM of STEMI decreased time to treatment and improved health outcomes. Despite agreeing that most paramedics were capable of providing PHM, regular maintenance of competence and medical overview were emphasized. Significant variations in perceptions were revealed regarding practical aspects of the PHM process and protocol, as well as ownership and responsibility of the patient. Success and failures of technology were also expressed. Varying arguments against a signed 'informed consent' were presented by the majority.

CONCLUSIONS

Focus group discussions provided key insights into potential barriers to and facilitators of PHM in STEMI. Although all groups were supportive of the concept and its benefits, concerns were expressed and potential barriers identified. This novel body of knowledge will help elucidate future educational programs and protocol development, and identify future challenges to ensure successful PHM of STEMI, thereby reducing reperfusion delay and improving patient outcomes.

Pre-hospital thrombolysis for acute ST segment elevation myocardial infarction: A survey of paramedics' perceptions of their role

BACKGROUND

The effectiveness of pre-hospital thrombolysis (PHT) in reducing mortality following ST segment elevation myocardial infarction (STEMI) is well established. In England, PHT is provided to around 17% of STEMI patients, and responsibility for treatment rests largely with paramedics rather than physicians as in some other countries, but little is known about how paramedics perceive their role, or whether age or experience influence such perceptions.

AIM

To describe paramedics' perceptions of PHT.

METHODS

Questionnaire survey to all 106 paramedics working within a single ambulance service in England.

RESULTS

60 (56.6%) paramedics responded. Overall, there were few significant differences by age or length of service in responses given. However, paramedics who had administered PHT gave more positive responses compared to those who had not, in relation to duty of care, professional image, individuals' influence on paramedic role development, and preparedness for practice.

CONCLUSION

Paramedics hold a range of views and perceptions of their role in delivering PHT; some of which appear to be related to age and length of experience, and actual administration of PHT. The vast majority view PHT as a positive step to providing patient care that is evidence based.

Paramedics' perceptions of their role in providing pre-hospital thrombolytic treatment: qualitative study

BACKGROUND

The majority of ambulance services in England provide pre-hospital thrombolysis, following publication of the National Service Framework for Coronary Heart Disease. A meta-analysis has confirmed the effectiveness of pre-hospital administration in terms of all-cause mortality reduction and time saved. Little is known however, about how paramedics perceive their role in thrombolytic administration.

AIMS

To describe ambulance paramedics' perceptions of their role in delivering thrombolytic treatment in the pre-hospital setting.

METHODS

Twenty paramedics, based in one rural ambulance service in the South West of England participated in focus group interviews.

RESULTS

Five key themes emerged: Perceptions of drivers for change; duty of care; perceptions of professional image; role expansion; and preparedness for practice.

CONCLUSION

Paramedics' perceptions of their role in pre-hospital thrombolysis were mixed, encompassing professional and political issues including lack of ownership of the emerging national strategy, desire for national certification and financial reward. For successful development and implementation of new strategies within the ambulance service early engagement of paramedics and other staff is essential.