Early thrombolysis for the treatment of acute myocardial infarction. Who will provide this treatment in the UK? Part II.

This article describes the successful provision of a thrombolysis service by general practitioners in the isolated rural area of Whitby, North Yorkshire, and also in rural areas of Sweden. It discusses the difficulties in providing such a service, particularly the rural/urban paradox whereby specialist pre-hospital thrombolysis services can be much more easily provided in urban areas than rural areas where the need is normally much greater.
The results of a small straw poll on thrombolysis amongst Primary Care Cardiovascular Society members show that rural general practitioners are much more interested in providing a pre-hospital thrombolysis service than their urban colleagues; paying a fee for such a service should be considered in future planning. The article also reviews the various thrombolytic agents favouring the use of fibrin-specific thrombolytic agents by bolus for pre-hospital thrombolysis.