Stages and potential barriers in the implementation of prehospital thrombolysis
| Stages | Potential barriers | |
|---|---|---|
| 1 | Identify and involve all stakeholders, ensuring regular consultation | Scepticism and resistance to change |
| 2 | Determine current practice: for example, local “pain to needle” times and the number of patients eligible for prehospital thrombolysis | Lack of reliable information |
| 3 | Consider the possible options and their relative costs: for example, measures to improve “pain to call” or “door to needle” times, approaches to prehospital thrombolysis | Lack of reliable financial data |
| 4 | Plan implementation, determine goals and set a realistic timetable | |
| 5 | Begin paramedic training, regarding the rationale behind thrombolysis and the acquisition/interpretation of the ECG. This should be tailored to local needs | Lack of funding to support initial and ongoing training |
| 6 | Purchase equipment and thrombolytic agent | |
| 7 | Continue paramedic training, to include those hospital staff who will be providing ECG interpretation and authorising thrombolysis | Fear of technology or unfriendly systems. Resistance to change in current working patterns and responsibilities |
| 8 | Begin “practice” ECG transmission to hospital without prehospital thrombolysis. Eligible patients could be given thrombolysis by the paramedic on arrival in hospital to boost confidence | “Teething problems” with equipment and ECG transmission |
| 9 | Commence prehospital thrombolysis, starting with the most straightforward cases | Unwillingness to administer thrombolytic drug: concerns regarding safety and side effects |
| 10 | Continuing training, audit and formal review by all involved parties | Decline in enthusiasm and interest over time |