Medical Practitioners’ Knowledge and Attitude on Prehospital ST Elevation Myocardial Infarction (STEMI) Thrombolysis

This study explores the knowledge and attitudes of medical practitioners with prehospital care (PHC) experience toward prehospital thrombolytic therapy for ST-elevation myocardial infarction (STEMI) management in Malaysia. While prehospital thrombolytic therapy shortens the door-to-needle time and improves outcomes, its implementation is hindered by the lack of local guidelines and limited training for prehospital providers. A cross-sectional survey was conducted at Hospital Canselor Tuanku Muhriz (HCTM) between November 2023 and May 2024. The participants included 65 medical practitioners with PHC experience. A validated questionnaire assessed knowledge and attitudes related to prehospital thrombolytic therapy, covering theoretical knowledge, electrocardiogram (ECG) interpretation and attitude statements. Chi-square tests analysed the association between knowledge and attitudes. Majority (93.8%) achieved acceptable knowledge levels, with 13.8% classified as having high knowledge. High proficiency was observed in ECG interpretation for STEMI cases, although challenges persisted with STEMI mimics such as left ventricular hypertrophy. Most participants (89.2%) exhibited positive attitudes toward prehospital thrombolysis. However, statistical analysis revealed no significant association between knowledge and attitudes (p = 0.715). The findings indicated adequate knowledge among medical practitioners but highlight gaps in managing STEMI mimics and prehospital workflows. Positive attitudes suggest readiness for implementation, though factors like medico-legal concerns and training opportunities may influence attitudes more than knowledge. This study demonstrates the feasibility of integrating medical practitioners in performing prehospital thrombolysis as a standard practice in Malaysia, emphasising the need for targeted training, advanced ECG interpretation courses and standardised protocols. Future research should expand to diverse regions and include broader provider cohorts.