Prehospital thrombolysis in acute myocardial infarction in a very sparsely inhabited area in northern Norway.

This study reports the experience gained in prehospital thrombolysis in acute myocardial infarction in a sparsely inhabited remote area of northern Norway. The study was retrospective from 1992 to 1999. The area covered was 49 000 km2, with a population of 75 000. During the study period only one out of 19 municipalities offered prehospital thrombolysis by general practitioners. Treatment was therefore accomplished by the use of an existing anaesthesiologist-manned rescue helicopter in the absence of available alternatives. The objectives were to evaluate whether prehospital thrombolysis was feasible, and if this approach improved access to early thrombolysis. A total of 272 patients with cardiac-related diagnoses were treated; 91 were considered prehospitally to have an acute myocardial infarction. The median delay from the onset of chest pain until first contact with the health system was 4 hours and 6 minutes or 4 hours and 10 minutes. A total of 23 patients were thrombolysed by the rescue anaesthesiologist prehospitally and four by general practitioners, whereas 58 had contraindications, mainly the duration of chest pain being greater than 6 h (24). Twelve of the 23 patients experienced hypotension and arrhythmia after the administration of streptokinase. Prehospital thrombolysis was feasible, but in order to improve access for patients, all general practitioners or ambulance personnel should administer treatment prehospitally. The public should be urged further to make early contact in cases of chest pain.

Long-range rescue helicopter missions in the Arctic.

BACKGROUND: Search and rescue helicopters from the Royal Norwegian Air Force conduct ambulance and search and rescue missions in the Barents Sea. The team on-board includes an anesthesiologist and a paramedic. Operations in this area are challenging due to long distances, severe weather conditions, and arctic winter darkness. METHODS: One-hundred, forty-seven ambulance and 29 search and rescue missions in the Barents Sea during 1994-1999 were studied retrospectively with special emphasis on operative conditions and medical results. RESULTS AND DISCUSSION: Thirty-five percent of the missions were carried out in darkness. The median time from the alarm to first patient contact was 3.3 hours and the median duration of the missions was 7.3 hours. Forty-eight percent of the missions involved ships of foreign origin. Half the patients had acute illnesses, dominated by gastrointestinal and heart diseases. Most of the injuries resulted from industrial accidents with open and closed fractures, amputations, and soft tissue damage. Ninety percent of the patients were hospitalized; 7.5% probably would not have survived without early medical treatment and rapid transportation to a hospital. CONCLUSION: Using a heavy search and rescue helicopter in the Barents Sea was the right decision in terms of medical gain and operative risk.