Abstract
The extent of myocardial damage occurring during acute myocardial infarction is time dependent. Current approaches designed to reduce the time between symptom onset and the initiation of thrombolytic therapy have focused on increasing public awareness of the need to seek prompt medical attention, prehospital administration of thrombolytic agents, and reducing inhospital delays in initiation of therapy. Results from short-term, public awareness campaigns suggest that patient delays in seeking medical assistance can be reduced in some communities; however, these campaigns do not influence overall patient use of emergency rooms and emergency transport services. In addition, the long-term benefit of media campaigns has not been demonstrated. Prehospital thombolytic therapy appears to be feasible and safe in certain communities, but definite therapeutic benefit of the small time savings realized in studies to date has not been seen. Even if prehospital thrombolysis is proven to benefit selected patients, it will not affect the large number of patients who choose not to use emergency medical transport services. Adherence to established protocols designed to facilitate rapid institution of thrombolytic therapy can reduce inhospital delays. Initiating thrombolytic therapy within 30 minutes of patient arrival in the emergency department is a goal that should be readily achievable in today's health care environment.