Appendix 3: Sample of the thrombolysis protocol development template to be used by hospital service (usually emergency) in developing a thrombolytic therapy protocol for AMI patients on arrival at hospital.

• Who will determine whether the patient is experiencing myocardial ischemia?

• What will the criteria be for determining whether the patient is experiencing myocardial ischemia?

• How will the patient be transported to a stretcher?

• Which stretcher or emergency-department area will the patient be transported to?

• What basic assessment or intervention will be provided within the first 10 minutes after the patient's arrival in the emergency department? (e.g., Heart monitor, recording or vital signs, oxygen therapy, insertion of intravenous line, blood tests, electrocardiography, administration of nitroglycerine, notification of emergency physician on duty or physician on-call for emergencies)

• What basic intervention or assessment will be provided within the second 10 minutes after the patient's arrival? (e.g., Assessment by emergency physician on duty or physician on-call for emergencies, determination of indications or contraindications for thrombolytic therapy, further treatment of chest pain)

• What further intervention or assessment will be provided within the third 10 minutes? (e.g., Infusion of thrombolytic agent if indicated, arrangement or transfer of patient to coronary care unit or other appropriate facility)

• Which basic blood tests will be needed and should blood samples be sent for testing before the physician has completed an assessment?

• What will the hospital or regional criteria be for indications and contraindications for thrombolytic therapy?

• Which thrombolytic agents will be available?

• If more than one thrombolytic agent will be available, what will the criteria be for deciding which agents to use?

• Where will the thrombolytic agents be stored?

• How will the thrombolytic agents be mixed?

• How will the thrombolytic agents be administered?

• What will the standard adjuvant therapy be (acetyisalicylic acid, heparin, beta-blocker, nitroglycerine)?

• Where will the thrombolytic therapy be administered? (e.g., in the emergency department before transfer of the patient; in the emergency department, with transfer of the patient; in the emergency department, with transfer of the patient after the infusion has been started; or after transfer of the patient [only if transfer can be performed and thrombolytic infustion started within 5 minutes of transfer])

• What will be the minimum nursing staff requirements be for appropriate observation of the patient during administration of thrombolytic therapy?

• What will the procedure be for obtaining cardiology consultation (if required)?