Tabulated Appraisal of Short List
The appraisal for each of the options remaining in the short list is listed in the following tabulation. They are each examined in detailed with regards to their projected benefits, costs and risks involved.
The following is the results for Option 2 and 3.
Tabulated Appraisal List
- Thrombolysis by an accompanying physician in the ambulance, (28) analogous to the French SAMU (Emergency Medical Services) Network model.
- The most obvious apparent benefit is the presence of the physician at the remote site with the patient. Although there is improved documentation and adherence to the protocols, the meta-analysis of the clinical trials have not shown any additional benefit in terms of patient outcome or other complication.(26)
- The cost would be prohibitive in terms of manning every ambulance with an acute physician.
- The rest of the cost expected would be fairly similar. I do not expect the French Ambulances to be any less equipped.
- The risks would be borne by the physician on site. There would be no ambiguity.
- Security of medical data transmission would not be an issue.
- Autonomous pre-hospital thrombolysis by trained paramedic crew.(34, 35)
- There could be a theoretical improvement in speed of initiating thrombolysis as the paramedics would not need to wait for the system to link up and the physician to arrive at CCU in order to interpret the ECG.
- There would also be no risk of technology failure with equipment or transmission.
- I do not expect a big difference in costs saved as the equipment, training and drug used would be the same. Remote telemetry decision support would still be necessary back-up.
- The risks would be the same. However, the paramedic crew would be acting solely on his own accord and may feel vulnerable in difficult situations. This may reduce the adoption rate and confidence of this service among the paramedic crew.
- However, it is possible that in the future, experienced members of the paramedic crew can take over this role of remote decision support at the scene itself.
This site complies with the HONcode standard for trustworthy health information:
17 May, 2017