The symposium Early thrombolysis – the realities and the practicalities which was an official satellite at the British Cardiac Society’s Annual Conference in Harrogate in May 2002 comes at an appropriate time. The government has recently announced that £14 million is to be made available for paramedic training, equipment for ambulances and thrombolytic drugs in England, in order to help achieve the targets set out in the National Service Framework (NSF) for Coronary Heart Disease (CHD). Also, the National Institute for Clinical Excellence (NICE) has made available its Appraisal Consultation Document for review by stakeholders. The document states that “patients with acute myocardial infarction in whom thrombolysis is indicated should receive thrombolytic treatment as soon as possible after the onset of symptoms”. This report reviews the symposium, which addressed many of the ‘nitty gritty’ aspects of optimising thrombolysis – the realities of lytic therapy administration by the ambulance service, experience from other countries and integrated care pathways in the UK. The following is an independent report, written by the British Journal of Cardiology editorial team and sponsored by an educational grant from Boehringer Ingelheim, who also organised the symposium.