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Impact of “dual response” on prehospital thrombolysis in remote and rural areas of Scotland: prospective observational study
  1. J Rawles1,
  2. A Marsden2
  1. 1Brunnion Minor, Lelant Downs, Hayle, UK
  2. 2Scottish Ambulance Service, National Headquarters, Edinburgh, UK
  1. Correspondence to:
 Dr J Rawles
 Brunnion Minor, Lelant Downs, Hayle TR27 6NT, UK;

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Despite its proved advantages,1 uptake of prehospital thrombolysis by general practitioners (GPs) in rural areas of Scotland has been poor.2 Some of the practical difficulties could be surmounted if GPs were assisted by ambulance paramedics trained and equipped for the management of acute myocardial infarction. This team working is the essence of “dual response”, a model of care proposed in 1994 by the British Heart Foundation but not implemented until now.3 In this project “dual response” was evaluated against the National Service Framework (NSF) standard of 60 minutes call to needle time.4


Twenty three ambulance locations were selected for inclusion in the project on the basis of distance from hospital (>30 minutes), adequate paramedic staffing, and expression of interest by local GPs. Patients from these areas were referred to seven district general hospitals (DGH). A protocol for immediate management of suspected acute myocardial infarction was agreed, and a training package developed and used in 20 one day joint workshops for GPs and paramedics. Ambulances in the participating centres were equipped with …

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  • Funding: NHS Scotland Remote and Rural Areas Resource Initiative (RARARI); educational grants from Boehringer Ingelheim and Roche Pharmaceuticals.

  • Conflicts of interest: none declared.

  • Ethical approval was not required for this study. The study was conducted, concluded, and reported independently of the funders.

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