Maximum benefit from
thrombolytic therapy in acute
myocardial infarction is obtained with
early therapy. The earliest possible time to treat is during the initial evaluation of the patient in the home or ambulance, which requires accurate diagnosis of acute
myocardial infarction in the prehospital setting. In our study, paramedics evaluated patients who had
chest pain with a 12-lead ECG transmitted by cellular telephone and a checklist for inclusion and exclusion criteria for
thrombolytic therapy. This information was transmitted to a hospital-based telemetry physician who diagnosed or excluded acute
myocardial infarction and made a mock decision to withhold or administer a
thrombolytic agent. Forty-eight patients with
chest pain were evaluated. Six were diagnosed as having overt acute
myocardial infarction by the hospital-based telemetry physician. All six patients had the diagnosis substantiated by both ECG and
enzyme studies on hospital admission. Based on the data supplied by paramedics, two of these six patients were considered eligible for
thrombolytic therapy by the physician. Hospital evaluation confirmed the prehospital decision to treat with a
thrombolytic agent. In addition, all other patients were appropriately diagnosed as ineligible. Prehospital ECG diagnosis resulted in two patients going directly to the catheterization lab, thereby bypassing the emergency department. Overt acute
myocardial infarction can be accurately identified by a prehospital-acquired 12-lead ECG transmitted to a hospital-based physician. Our study demonstrates that in conjunction with specially trained paramedics, the hospital physician can decide whether to administer
thrombolytic therapy to such patients in the prehospital setting.