Summary of DH Questionnaire Feb/Mar 2003

1. Vehicles and 12-lead ECG machines (number/type/shortfall at March 2003/04)
2. Pre-alerting of hospitals (whether ambulance crews pre-alert and/or telemetry)
3. Training and education (in 12-lead ECG interpretation and thrombolysis)
4. Thrombolysis (Which trusts, number of patients, plans for introduction)

1. Vehicles and 12-lead ECGs
   1. At March 2003 there are 2594 front line ambulance vehicles. This figure includes some fast response vehicles and also some equipped manager cars.
   2. By March 2004 this figure is expected to rise to include 2632 front line ambulance vehicles.
   3. Of the 2594 existing frontline vehicles, 1389 (54%) are equipped with 12-lead ECG machines.
   4. By March 2004 this figure is expected to rise to 2039 (77%) vehicles equipped with 12-lead ECGs.
   5. The majority of services use the Physio-Control Lifepak-12, whilst others use those made by Zoll, Marquette and Mobi-med.


2. Pre-alerts/Use of telemetry
   
   1. 29 (94%) currently pre-alert receiving units of incoming patients that are seriously ill. One trust is planning to introduce pre-alerting and one trust stated ‘sometimes’ as their response to this question.
   2. 11 (35%) trusts currently transmit ECGs to the receiving unit. 5 Trusts stated that they sometimes do, whilst 2 trusts are planning to introduce telemetry and the remaining 13 ( ) trusts do not transmit ECGs.
   3. 15 Trusts use telemetry systems to transmit 12-lead ECG data. 7 Trusts use Facsimile machines whilst 3 use mobile telephones. A further 3 trusts are planning the introduction of telemetry by the end of 2003.
   4. 43% of frontline vehicles currently have the facility to transmit 12-lead ECG data. This compares with 41% of receiving hospitals that are equipped with telemetry receiving equipment.
   5. Trusts were asked who assesses and advises upon the transmitted ECGs at the receiving units. In 5 trusts Cardiologists view the ECG. In 15 trusts CCU nurses, and in 12 trusts A&E dept staff (not specified which grade). There is some overlap between trusts.


3. Training and Education (the Q’s did not specify 12-lead or 3-lead. This is reflected by the provision of vague answers)
   1. 29 (94%) trusts provide training in the clinical and risk assessment of AMI patients. One trust each stated ‘planned’ and ‘N/A’.
   2. 27 (87%) trusts stated that they provide ECG interpretation as part of the paramedic training, 2 trusts planning to, one trust provides 3-lead ECG interpretation and one trust does not provide ECG training (might it be assumed that they are referring to 12-lead interpretation?)
   3. 30 (97%) trusts provide training in IV drug administration as part of paramedic training. One trust does not include this training.
   4. 65% of trusts provide education on thrombolytic drugs. 52% of trusts provide thrombolysis education as part of general paramedic education.


4. Thrombolysis
   1. 8 (26%) trusts are currently providing thrombolysis, (another one trust stated ‘some’) with a further 19 (61%) trusts planning to provide thrombolysis. One trust stated that they had no plans to provide thrombolysis.
   2. To date 81 patients have received paramedic led thrombolysis.
   3. Of the trusts that currently provide thrombolysis, 6 use Tenecteplase and 3 use Reteplase.
   4. Of the 19 trusts planning to implement thrombolysis, 7 have stated a preference for Tenecteplase. The remaining trusts have not specified a preference.