[CARPA] Re: cardiac thrombolysis in remote areas.

[Fran Vaughan]

Erik 

There is a protocol for the use of thrombolytics in the CARPA standard treatment manual (4th ed p 35) and most clinics in Central Australia are now keeping it, although it was slow to be adopted for the same reasons. Although the protocol say reteplase, it could easily be substituted by tenecteplase. As you know, time is the essence and planes don't always arrive within the magical 4 hours! 

It is the responsibility of the health service to provide equipment for monitoring and training for nurses so that it can be used promptly and safely. Perhaps some other 'listers' can comment on the available training in the region? 

Of course, it is under the supervision of a doctor and nurses have the right to refuse to provide any treatment they don't feel they are competent to provide. But I don't think the risk of reperfusion arrhythmia if it is given, outweighs the risk of death if it is not! 

It is covered under S100 so no cost to the health service even if it goes out of date every 2 years! 

Fran 



>>> "EriK Van Den Berg" <erik_vandenberg at health.qld.gov.au> 19/01/2007 9:01:36 am >>>


Just wondering if any of the remote areas are keeping and using Thrombolytics in their clinics for administration by NURSES under the direction of a remote doctor. In the Cape York area a few of the clinics keep Tenecteplase but there is no consistant policy as to who, when, how etc. A quick read of info on the internet shows that paramedics are using thrombolytics in remote areas of Scotland * where they may be a few hours away by road from the nearest hospital. Locally there is some resistance from some people regarding the ability of remote nurses to manage reperfusion arrhythmia’s. Has any-one else been down this road and managed to get suitable guidelines and protocols and training in place? If so it would be great to hear about it. Thanks ErikErik van den Berg
Outreach Pharmacist
Cairns Base HospitalPH 4050-6287
FAX 4050-6585


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