Appendix 2: Sample of the Prehospital Thrombolytic checklist to be used by ambulance attendants during transportation of a person suffering AMI to hospital

Patient history                                               Response

Surgery within 4 weeks                                    Yes          No

Stroke or transient ischemic attack within 6 months       Yes          No

Major trauma within 4 weeks                               Yes          No

Bleeding ulcer or gastrointestinal bleed                  Yes          No

Intracranial tumour, bleed, arteriovenous malformation
 or aneurysm                                              Yes          No

Bleeding disorder                                         Yes          No

Liver disease                                             Yes          No

Kidney disease                                            Yes          No

Diabetes-related eye disease                              Yes          No

Surgery involving central nervous system within 6 months  Yes          No

Childbirth within 6 weeks                                 Yes          No

Streptokinase therapy within 6 months                     Yes          No