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Background: If properly organised, prehospital thrombolysis in acute myocardial infarction saves time to treatment and improves outcome. We have evaluated a quality assurance program for general practitioner-based (GP-based) prehospital thrombolysis., Material and Methods: GPs and the local ambulance service in eight local communities went through a one-day training programme. The GPs interpreted the ECGs themselves and initiated prehospital thrombolysis according to a set of criteria. Patients with prehospital thrombolysis were prospectively compared with patients receiving hospital thrombolysis during the same time period., Results: From 1999 to 2001, 69 patients received prehospital thrombolysis: 50% of all patients receiving thrombolysis. No complications were attributed to prehospital administration; 66 out of 69 patients received thrombolysis on a correct indication. The median call to needle time was reduced from 145 to 63 minutes in patients treated before arrival at a hospital, which gives a median of 82 minutes of time saved., Interpretation: GP-initiated prehospital thrombolysis is safe after proper training and saves clinically important time to treatment compared with hospital administration.

Background: Targeted emergency medical responses with minimum time loss require a well organized emergency medical system (EMS). We studied time consumption from emergency call reception to the arrival of the ambulance unit in two dispatch centres serving two demographically different Norwegian regions., Material and Methods: We analysed 5004 emergency "code red" calls during 2001 processed by an EMS serving 367 000 inhabitants in 28 mixed urban/rural municipalities in Vestfold and Troms counties. Dispatch centre process time, ambulance (ground, air or boat) response time and total access times were measured., Results: Total pre-hospital access time from call reception to arrival of ambulance to patient were considerably longer than the suggested national goals, which were only met in two rural areas out of the 28 municipalities studied. Median pre-hospital response time was 10 minutes in both regions. Within 12 minutes from the emergency call, 62.9% of the population in Vestfold and 59.8% in Troms were reached by ambulance., Interpretation: National standards for pre-hospital response times in medical emergencies are neither met in densely populated cities, nor in less populated rural areas.