Do paramedics have/use clot busting drugs?

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patzyboi

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Do they? On national standards
 
Some places have fast mag in the field but its very limited as far as i know. Mostly a trial with depts
 
In the county where I work there's an ambulance that is way way way far out in the sticks, and the weather is so poor (fog or rain) that generally they wind up transporting by ground. Their nearest hospital is roughly an hour away, but depending on the call they may be three hours out. As such, they were granted an expanded scope that includes TPA for STEMI patients. So far I think they've only used it a handful of times since it was introduced, but it was certainly an interesting development.
 
Joe said:
Some places have fast mag in the field but its very limited as far as i know. Mostly a trial with depts
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Fast mag?
 
New Zealand has had thrombolysis for myocardial infarction for many years and has used it very successfully. I believe it is being rolled out nationally from next year.
 
Generally, no. There was talk about using them from CVAs, but without a CT scan, it's nearly impossible to differentiate between a hemorrhagic stroke and an Ischemic stroke.

I heard rumors that some agencies are piloting programs for STEMIs, but not in any areas that that I have heard about.
 
patzyboi said:
Do they? On national standards
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I believe in the new education model it is but I am not sure if schools are currently using it. There is another thread here talking about the transition from NREMTP to NRP... I believe this is mentioned in that thread.
 
Tim Is correct, the answer is Yes.
"Initiation and monitoring of thrombolytic medication" is now a new national standard for the NREMT "NRP" level
 
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We have had it here in Nova Scotia for a couple of years now. It is not something we do everyday. There is a strict protocol of how they want it done. This includes faxing it off to the nearest regional hospital for the ER Dr to confirm and order it. It was part of my ACP education.
 
Joe said:
http://www.fastmag.info/

Seemed like a big deal when i was in la county.
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Thanks, First time I have heard of that. From a quick read it seems they are using mag for its neuroprotective properties and not as an actual treatment to lyse the clot.
 
If I recall correctly, Miami-Dade Fire was giving Retavase to STEMI patients starting about 10 years ago. They have gotten away from it in favor of a large number of STEMI Centers with a 60 minute cath window.
 
Out Intensive Care Paramedics carry tenecteplase for use with STEMI pt's.

They have to meet certain strict criteria, sign consent and an interventional cardiologist must be contact. Depending on the day / time it is and distance to hospital they will use it on STEMI pt's
 
We've had it for 10 years. It's great when transport times are prolonged, or cathlab availability is limited.
 
Joe said:
http://www.fastmag.info/

Seemed like a big deal when i was in la county.
Click to expand...

And in Orange County. I did my internship with LAFD who was participating in the study, had a couple of patients who met criteria (bs between 80-400, not bedridden, age dependent, things of that nature) but its a long process to enroll somebody in the study. Ended up basically just not using the drugs. Its a double blind study so you don't know if its the actual drug or just NS. Wasn't worth the extra time on scene to me for a CVA.
 
Greenville County EMS in SC did Retaplase back in the 90's but it was phased out when more hospitals in the area became cath capable.
 
In Alberta we've been using it for almost 10 years. Started off as a trial in 2003-2006 and now part of STEMI protocol.

STEMI identified with protocol meeting elevation, associated S/S, 12 lead transmitted to one of a dozen Cardiologists on call provincially, follow up with a phone call and clinical discussion with the Dr, factors considered such as transport time, cath lab availability, severity of the STEMI, etc. Consent form and relative/absolute contraindications reviewed, drugs given (plavix, IV& SC Enoxaparin (age based), and tPa IV. Alternative PCI route if available - Brilinta, Enoxaparin, transport direct to PCI suite. Personally I have probably done about 15 enrolments to date with approximately 50% going tPa rotue.

This is not reserved for rural applications, in fact the start of this trial in 2003 was in an 1 million pop. urban area. 2 locations in Edmonton that provide primary PCI.

As for CVA i doubt that will ever be seen in EMS in this Province.. The Alberta Provincial Stroke Strategy has enabled the province to establish availability of a CT scan within the window of thrombolytic for CVA (4.5 hours is standard here with trials up to 6 hours). Rapid transport to a Stroke site or a alternative stroke site (with CT and teleconference with Neurologists) then administration of the thrombolytic as required.
 
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Interestingly enough we have also been trialing a program in NSTEMI patients to feild test blood for Troponins and BNP. Positive results I believe are sent to a PCI facility for immediate workup and PCI.

Sorry would have added to previous post but the 10 min window passed.

Additionally for CVA we were trialing magnesium about 5 years ago. Study titled MINUTES (magnesium induced neuroprotective... ???) where we would call the "Stoke Team" on call neurologist and he would check the study and we would either enroll or not enroll. I believe it was 1-2g of Mag IV Infusion over 10 minutes. No word on where that study went to but we no longer do it.
 
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