Introduction Reperfusion therapy in ST Segment Elevation Myocardial Infarction (STEMI) is the major therapeutic goal. 1 Rapid initiation of reperfusion therapy for STEMI is achieved with either fibrinolytic therapy or primary percutaneous coronary intervention (pPCI). 2,3 In a country like Pakistan, where primary PCI is virtually not available to vast majority of our population, fibrinolysis remains the mainstay of reperfusion strategy. Fibrinolytic therapy instituted during the first hour has remarkable outcome 4,5 and even within 3 hours after symptom onset, can result in mortality reduction of up to 50%. 2,3 In Pakistan, having few cardiac centres catering to major cities offering limited number of primary PCI, the majority of STEMI patients from rural and urban population are treated in emergency departments and coronary care unit (CCU) of general hospitals wherein timely delivery of thrombolytic treatment is hampered due to a number of reasons. Lack of awareness of symptom recognition by patients and their relatives, accurate appraisal by general practitioners (GPs), distance to facility and mode of transportation 6 are among the most important factors leading to delay in presentation, thus prolonging total time (TT) to treatment, and resulting in worse outcome in a large number of the patients. The Punjab government has established emergency medical services (EMS) Rescue 1122 in all the major districts of the province. 7 This is the first trained Emergency Rescue Medical Service established in Pakistan according to international training standards. The service is providing efficient and effective rescue and transportation to the helpless victims of accidents, emergencies and disasters. 8 Furthermore, emergency departments (EDs) of general care hospitals in Pakistan, like most of the developing countries, are not providing prompt fibrinolysis and, hence, door-to-needle time (DNT) is higher than recommended. 9 The first chest pain unit (CPU) was Vol. 63, No.2, February 2013 194 1,2,5-10 Department of Cardiology, 3 Department of Community Medicine, 4 Private Patient Block, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, Pakistan. Correspondence: Syed Faiz ul Hassan Rizvi. E-mail: drsfaiz@yahoo.com ORIGINAL ARTICLE Prompt delivery of Thrombolytic therapy: Experience with chest pain units and emergency medical services Syed Faiz-ul-Hassan Rizvi, 1 Saeed-ur-Rehman Bajwa, 2 Ghulam Mustafa, 3 Daniyeh Khurram, 4 Ahsan Niaz, 5 Shakeel Akhtar, 6 Aamir Javaid, 7 Shahid Mahmood, 8 Hina Masood, 9 Komal Asghar 10 Abstract Objective: To reduce the reperfusion time with thrombolytics. Methods: The study was done at Sheikh Zayed Hospital, Rahimyar Khan, between January and October 2009, and comprised all consecutive patients with ST segment Myocardial Infarction presenting to the hospital in emergency. In phase one, emergency medical services of Rescue 1122 were utilised to minimize transportation time and thrombolytics were instituted in the Emergency Department or the Coronary Care Unit. In Phase II, a chest pain unit was established in the Emergency Department and all patients were thrombolysed there. A proforma describing Total time, Door-to-needle time, demographics, reperfusion criteria, immediate and delayed complications was filled up for each patient. Comparative groups were analysed using Chi-square and Kruskal-Wallis tests, and p<0.05 was considered statistically significant. Results: A total of 291 patients were enrolled. Of them 15 (5.15%) were rescued by the emergency medical services, while 276 (94.84%) presented themselves or were referred. Mean age was 51±11.5 years. There were 245 (84%) males. Thirty (10.30%) patients were thrombolysed at the Chest Pain Unit; 216 (74.22%) at the Coronary Care Unit; and 45 (15.46%) in the Emergency Department. Total time was 3:52, 5:29, and 4:55 hours respectively (p=0.003). Door-to-needle time was significantly reduced in the chest pain unit (p=0.0001). Total time was minimum in emergency medical services (p=0.0001). ST segment resolution >70% was maximum in the chest pain unit (p = 0.0001). Conclusion: There was remarkable reduction in Total time utilising emergency medical services and door-to-needle time by establishing the chest pain unit. It is strongly recommended that such units be developed in all districts and tertiary care hospitals as a cost-effective facility. Keywords: Emergency medical services, Chest pain units, Thrombolytic therapy. (JPMA 63: 194; 2013)