Is there any place for GPs to carry thrombolysis medications?
Half of all cardiac deaths from coronary thrombosis occur within 75 minutes of onset. Prompt administration of thrombolytics improves 30-day survival by 6-8 per cent if given within 60 minutes of onset and by 3-5 per cent if given within three hours. The national service framework standard 6 requires a call to needle time of 60 minutes to be achieved. The current consensus is that of the three time variables (call to needle, transport time to hospital, hospital door to needle time) only the third can be reliably reduced by better organisation. Proper safe administration of thrombolytics requires a 12-lead ECG to be reliably interpreted and possession of a defibrillator as reperfusion dysrhythmias are common. So there are significant logistical and skill issues to be addressed as well as the revenue consequences of the thrombolytic exceeding its shelf-life before use. In Scotland the drug is obtained under stock order whereas in England and Wales the GP bears the financial risk under pa
