Goal 2: Reduce Human Disease

Improving pre-hospital therapy of HLB disorders

There is compelling evidence that pre-hospital therapy of both stroke and MI can improve outcomes and yet, with the exception of aspirin for MI, almost no care is administered pre-hospital in the U.S. NHLBI has a major stake in improving pre-hospital care because there already are sufficient data to show that currently available interventions would improve outcomes if they could be administered in the prehospital setting. There is also the need to spur development of novel agents that can be readily administered in the pre-hospital setting, as for example, by auto-injector. There is also the need to assess the impact of increasing the diagnostic capabilities in the pre-hospital setting.

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Critical Challenge (CC)

Details on the impact of addressing this CQ or CC

The mortality and disability from stroke could be substantially reduced. The early mortality of STEMI and late disability from heart failure could be substantially reduced.

Feasibility and challenges of addressing this CQ or CC

There are numerous challenges including:
• Obtaining informed consent for pre-hospital clinical trials
• Fragmentation of EMS services by locale
• Need to train EMS personnel
• CMS rules on reimbursement for ambulance services and novel drugs

NHLBI could use its convening power in partnership with other groups to integrate this effort.

Name of idea submitter and other team members who worked on this idea Barry Coller

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Idea No. 1005