• Helen Cox, John W Albarran, Tom Quinn, and Kathrine Shears.
• Faculty of Health and Social Care, University of the West of England, Glenside Campus, Bristol, BS16 1DD, UK. helen3.cox@uwe.ac.uk
• Accid Emerg Nurs. 2006 Oct 1;14(4):237-44.

BackgroundThe majority of ambulance services in England provide pre-hospital thrombolysis, following publication of the National Service Framework for Coronary Heart Disease. A meta-analysis has confirmed the effectiveness of pre-hospital administration in terms of all-cause mortality reduction and time saved. Little is known however, about how paramedics perceive their role in thrombolytic administration.AimsTo describe ambulance paramedics' perceptions of their role in delivering thrombolytic treatment in the pre-hospital setting.MethodsTwenty paramedics, based in one rural ambulance service in the South West of England participated in focus group interviews.ResultsFive key themes emerged: Perceptions of drivers for change; duty of care; perceptions of professional image; role expansion; and preparedness for practice.ConclusionParamedics' perceptions of their role in pre-hospital thrombolysis were mixed, encompassing professional and political issues including lack of ownership of the emerging national strategy, desire for national certification and financial reward. For successful development and implementation of new strategies within the ambulance service early engagement of paramedics and other staff is essential.

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