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Impact of “dual response” on prehospital thrombolysis in remote and rural areas of Scotland: prospective observational study

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 …