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Is anyone aware of any pre-hospital service in India that already does or aims to provide pre-hospital thrombolysis for acute MI. Agreed that PCIs are fast becoming the norm in big towns/cities with an abundance of corporate hospitals!!! Considering the long distances to travel to these centres from remote villages, pre-hospital thrombolysis could well be the answer.

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I feel I should post the same query with a different slant.

Is there a role for 'pre-hospital thrombolysis' in India, considering the long distances from most of our rural areas to a reasonable hospital with some facilities?

If so, is it difficult to achieve?

I understand there is the issue of training medical and EMS personnel!!!

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there are very few formal ems training programs. i think it is important to get the basics right in ems service in india before venturing into out of hospital thrombolysis.

arun.

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It will another a few years before the EMTs in India get to a level where they can administer thrombolytics in the ambulance. The current level of training does not include this level of decision making.

Placing an ECG machine, a defibrillator, a chart showing MI and arrhythmia management protocols with a stock of streptokinase in the primary health centres in our villages is the best thing that can happen to 'Rural Acute Coronary Syndrome Management'!

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i do agree with all the statements made above.
but being a technologically rich country, i think we should make use of what we have.
i mean simple things like, having a multimedia snap of the ecg taken and forwarded to a centrally established medical control, video calling phones, etc.
which can then advise on the drug to be given,
i mean, such things are a possibility, i think, along with the establishment of EMT training sites, its also important to have a good medical central control established, that can make these decisions for the paramedics.
as experience grows, we could move to EMS initiated t'lysis.

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Though it may be a bit early for some of the states, EMS is reasonably well set-up thanks to a few organisations, in other states. These systems have grown well and are past their infantile state.

Going by the kind of technological inputs some of these organisations have, things like telemetry would soon be a thing of the past. Morpheus, your idea of a centralised control with qualified clinicians giving advise over a phone to EMS personnel is already happening.

Having said all of this, why can't our primary health centres be equipped/trained to provide such a service? At least in the remote villages and towns???