Is prehospital thrombolysis beneficial to patients suffering acute MI?

Prehospital thrombolysis (PHT) plays an important role in enabling health care trusts to achieve the call-to-needle time of 60 minutes in England and Wales, but its potential value for each patient must be weighed up by the attending paramedic, taking into account local demographics, availability of alternatives such as primary coronary angioplasty (PCA) and the restrictions of the JRCALC guidelines regarding eligibility of the patient. In light of the deteriorating effectiveness of PHT over time and its expense, in some areas money may well be better spent educating the public to call for help at an earlier stage, as well as encouraging direct admission where available to PCA by paramedics as an alternative to PHT. However, until there is an equal eligibility of patients for thrombolysis in both the prehospital and hospital settings, it is difficult for paramedics in the field to weigh up the relative effectivenes of one against the other.