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I'm a volunteer ambulance officer in Western Australia. We certainly don't carry thrombolytic agents. What we do have though is a protocol for getting stroke pa

I'm a volunteer ambulance officer in Western Australia. We certainly don't carry thrombolytic agents. What we do have though is a protocol for getting stroke patients (with good predicted outcomes) into a helicopter or fixed-wing aircraft ASAP so they can get to a hospital with a thrombectomy (clot retrieval) service. If called promptly, then there shouldn't be many patients that we can't get to the right care within a suitable timeframe.

autokad 9y ago
> "If called promptly, then there shouldn't be many patients that we can't get to the right care within a suitable timeframe." I worked with stroke centers, doctors, etc in building stroke access systems, and that doesn't fly with reality. Number 1, is that its hard for patients to recognize they are having a stroke. so "If called promptly" is a bit of unrealistic idealism. Although they say 4 hours, tPA administered after 1 hour has lost most of its benefit, and places that can do thrombectomy 24/7 (in US dedicated stroke centers) is not numerous. You are losing a lot of that hour just for time for the helicopter to warm up, find a spot, and land + your ambulance time getting to /stabilizing the patient. I'm sure the patients on your beat had suitable access, but that's a bit of selectivity bias no? In the US, although the majority of the population is within the golden hour, there are still a ton of population that does not have access to a stroke center. I find it extremely hard to believe that this is not the case in Australia - where I have heard stories of people getting a finger cut off and having to drive 3 hours to the nearest hospital.
- thisrod 9y ago
  Remember that Australia is ridiculously urbanised. About 80% of Western Australians live in Perth. Contrasted to the US, the most remote Australians must be a lot further from a referral hospital, but the median Australian might actually be closer.
thisrod 9y ago
Is there any possibility that Australia would allow volunteers to administer drugs this dangerous, no matter how effective those drugs were? Not to be rude—I volunteer for an emergency service too.
- thomasfedb 9y ago
  Asprin, paracetamol, glucose, adrenaline (epinephrine) auto-injectors, salbutamol, glyceryl trinitrate (GTN), methoxyflurane, ondansetron, cophenylcaine (lidocaine + phenylephrine) - that's our volunteer drugs in WA. We're hoping that eventually ketamine will be added. I don't see tPA ever being on that list.
robbiep 9y ago
That's interesting. Where I trained (central coast, Hunter New England) they do but only for STEMIs, administering'should' occur after a scan in the Ed otherwise

autokad 9y ago

> "If called promptly, then there shouldn't be many patients that we can't get to the right care within a suitable timeframe." I worked with stroke centers, doctors, etc in building stroke access systems, and that doesn't fly with reality. Number 1, is that its hard for patients to recognize they are having a stroke. so "If called promptly" is a bit of unrealistic idealism. Although they say 4 hours, tPA administered after 1 hour has lost most of its benefit, and places that can do thrombectomy 24/7 (in US dedicated stroke centers) is not numerous. You are losing a lot of that hour just for time for the helicopter to warm up, find a spot, and land + your ambulance time getting to /stabilizing the patient. I'm sure the patients on your beat had suitable access, but that's a bit of selectivity bias no? In the US, although the majority of the population is within the golden hour, there are still a ton of population that does not have access to a stroke center. I find it extremely hard to believe that this is not the case in Australia - where I have heard stories of people getting a finger cut off and having to drive 3 hours to the nearest hospital.

thisrod 9y ago
Remember that Australia is ridiculously urbanised. About 80% of Western Australians live in Perth. Contrasted to the US, the most remote Australians must be a lot further from a referral hospital, but the median Australian might actually be closer.

thisrod 9y ago

Is there any possibility that Australia would allow volunteers to administer drugs this dangerous, no matter how effective those drugs were? Not to be rude—I volunteer for an emergency service too.

thomasfedb 9y ago
Asprin, paracetamol, glucose, adrenaline (epinephrine) auto-injectors, salbutamol, glyceryl trinitrate (GTN), methoxyflurane, ondansetron, cophenylcaine (lidocaine + phenylephrine) - that's our volunteer drugs in WA. We're hoping that eventually ketamine will be added. I don't see tPA ever being on that list.

robbiep 9y ago

That's interesting. Where I trained (central coast, Hunter New England) they do but only for STEMIs, administering'should' occur after a scan in the Ed otherwise