Abstract W P187: Utilization of Emergency Medical Services to Transfer Acute Stroke Patients Directly to Scanning Reduces the Length of Time to Scan Result

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Scott Dunbar ◽  
Theresa Hoffecker ◽  
Avery Schwenk
Keyword(s):  
Acute Stroke ◽  
Ct Scan ◽  
Emergency Medical Services ◽  
Ct Scanning ◽  
Medical Services ◽  
Time Of Arrival ◽  
Stroke Patients ◽  
Emergency Medical ◽  
Number Of Patients ◽  
The Mean

Background: Rapid assessment and treatment of acute stroke patients including computerized tomography (CT) scanning to determine the need for tissue plasminogen activator (tPA) has been shown to be vital to positive patient outcomes. As part of an ongoing effort to reduce door-to-needle time for such patients, the door-to-CT result time was identified as an area that could be reduced by collaborative effort between Emergency Medical Services (EMS) and Emergency Department (ED) staff. We hypothesized that implementing an EMS protocol for direct-to-CT scanning as part of a collaborative stroke alert protocol would reduce overall door-to-CT result time. Methods: Local EMS and ED implemented criteria to alert the ED of acute stroke patients being transported to their facility. This alert included an estimated time of arrival and was sent to radiology, neurology, registration and pharmacy. Upon arrival, the patient was met by ED personnel while still on the EMS gurney. If the ED physician concurred with the field impression of acute stroke, the patient was taken directly to CT scanning by EMS. Data on time of door-to-CT result were collected from 7/9/12 to 7/8/13 and divided into those patients who received a stroke alert from EMS (n=41), and those who did not (n=81). All data are expressed as mean ± standard error. Results: The time for door-to-CT result was reduced (p<0.0001) for patients who received a stroke alert from EMS [16.5 ± 1.2 vs 31.6 ± 1.5 minutes, alert vs no alert, respectively]. Similarly, in the subset of patients who received tPA after the CT scan, the mean time door-to-CT scan results was reduced (p<0.005) in those patients who received a stroke alert from EMS (14.3 ± 1.1 vs 36.4 ± 7.3 minutes, alert vs no alert, respectively). Conclusions: Implementation of a stroke alert including a direct-to-CT protocol by EMS significantly reduced the mean door-to-CT result time in acute stroke patients. Expanding this protocol to include other area EMS services and hospitals could potentially result in a greater number of patients benefiting from these reduced times.

scholarly journals Variability in Criteria for Emergency Medical Services Routing of Acute Stroke Patients to Designated Stroke Center Hospitals

2015 ◽  
Vol 16 (5) ◽  
pp. 743-746 ◽  
Author(s):  
Nikolay Dimitrov ◽  
William Koenig ◽  
Nichole Bosson ◽  
Sarah Song ◽  
Jeffrey Saver ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Emergency Medical Services ◽  
Medical Services ◽  
Stroke Patients ◽  
Emergency Medical ◽  
Stroke Center

Abstract TP250: A Substantial Rate of Neurological and Non-Neurological Stroke Mimics Are Transported by Emergency Medical Services for Acute Stroke Evaluation

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Joel N Briard ◽  
Rahel T Zewude ◽  
Mahesh Kate ◽  
Ken Butcher ◽  
Laura C Gioia
Keyword(s):  
Acute Stroke ◽  
Emergency Medical Services ◽  
Final Diagnosis ◽  
Medical Services ◽  
Cross Sectional ◽  
Stroke Mimics ◽  
Emergency Medical ◽  
Number Of Patients ◽  
Suspected Stroke ◽  
The Impact

Introduction: The impact of prehospital triage of stroke mimics to designated stroke centers may be considerable, yet little information exists regarding stroke mimics in the prehospital setting. We aimed to describe the rate and clinical characteristics of neurological and non-neurological stroke mimics transported by Emergency Medical Services (EMS) to the Emergency Department (ED) for acute stroke evaluation. Methods: A retrospective, cross-sectional, observational analysis of a centralized EMS database of patients transported by EMS to the ED for suspected stroke during an 18-month period. Hospital charts and neuroimaging were utilized to determine the final diagnosis (acute stroke, stroke mimic, as well as specific underlying diagnoses). Results: A total of 960 patients were transported by EMS to the ED with suspected stroke, among whom 405 (42.2%) were stroke mimics (mean age ± SD: 66.9 ± 17.1 years; 54% male). Stroke mimics were neurological in origin in 223 (55.1%) patients and non-neurological in 182 (44.9%). Most common neurological diagnoses were seizures (n=44,19.7%), migraines (n=42,18.8%) and peripheral neuropathies (n=25, 11.2%). Most common non-neurological mimics included cardiovascular (15.9%), psychiatric (11.9%), and infectious (8.9%) diagnoses. Neurological mimics were younger (64.1 ± 17.3 years) than non-neurological mimics (70.5 ± 16.1 years, p<0.001). Median prehospital Glasgow Coma Scale scores were similar between groups (15 vs. 15, p=0.26). Mean prehospital systolic blood pressure was slightly higher in neurological (147.8±24.2 mmHg) than non-neurological mimics (141.2±26.2 mmHg, p=0.01). Conclusions: Stroke mimics represent a substantial number of patients transported by EMS for suspected stroke, with a considerable amount being non-neurological in origin. Prospective prehospital studies are warranted to help refine prehospital identification of acute stroke and thus minimize the number of stroke mimics transported by EMS for acute stroke evaluation.

scholarly journals Impact of COVID-19 on Emergency Medical Services for Patients with Acute Stroke Presentation in Busan, South Korea

2021 ◽  
Vol 11 (1) ◽  
pp. 94
Author(s):  
Jiyoung Kim ◽  
Choongrak Kim ◽  
Song Yi Park
Keyword(s):  
South Korea ◽  
Acute Stroke ◽  
Emergency Medical Services ◽  
Processing Time ◽  
Medical Services ◽  
Processing Times ◽  
Emergency Medical ◽  
Number Of Patients ◽  
Comprehensive Stroke Center ◽  
The Impact

The purpose of this retrospective observational study was to identify the impact of COVID-19 on emergency medical services (EMS) processing times and transfers to the emergency department (ED) among patients with acute stroke symptoms before and during the COVID-19 pandemic in Busan, South Korea. The total number of patients using EMS for acute stroke symptoms decreased by 8.2% from 1570 in the pre-COVID-19 period to 1441 during the COVID-19 period. The median (interquartile range) EMS processing time was 29.0 (23–37) min in the pre-COVID-19 period and 33.0 (25–41) minutes in the COVID-19 period (p < 0.001). There was a significant decrease in the number of patients transferred to an ED with a comprehensive stroke center (CSC) (6.37%, p < 0.001) and an increase in the number of patients transferred to two EDs nearby (2.77%, p = 0.018; 3.22%, p < 0.001). During the COVID-19 pandemic, EMS processing time increased. The number of patients transferred to ED with CSC was significantly reduced and dispersed. COVID-19 appears to have affected the stroke chain of survival by hindering entry into EDs with stroke centers, the gateway for acute stroke patients.

Abstract 3633: A National Assessment of Factors Influencing Emergency Medical Services Times Among Acute Stroke patients.

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Vikram Jadhav ◽  
Saqib A Chaudhry ◽  
Gustavo J Rodriguez ◽  
M. Fareed K Suri ◽  
Adnan I Qureshi
Keyword(s):  
Acute Stroke ◽  
Emergency Medical Services ◽  
Symptom Onset ◽  
Emergency Services ◽  
Medical Services ◽  
Time Interval ◽  
Stroke Patients ◽  
Accurate Identification ◽  
Critical Determinant ◽  
Emergency Medical

Background: The time spent in Emergency Medical Services [EMS] assessment and transport is a critical determinant of time interval between symptom onset and treatment for acute stroke. Objective: To study the determinants that influence EMS times which is a composite of response, assessment, and transport times for acute stroke patients. Methods: The 2009 national Emergency Services Information System [NEMSIS] Research dataset representing 26 states in US was accessed to identify the patients diagnosed by EMS personnel to be having stroke / cerebrovascular accident [CVA] on arrival at the scene of incident. Total EMS times defined as time interval between dispatch call and completion of transport to emergency department [reported in mins (confidence intervals)] were calculated and compared in various patient strata defined by factors such as dispatch center identification of stroke / CVA, barriers (language and physical) at the scene, location and demographical factors. Results: A total of 52282 patients were identified to have stroke / CVA by EMS personnel on arrival at scene. Significant differences were seen in EMS times with accurate identification compared to non-identification of stroke / CVA by dispatch center [41.8 (41.5-42.2) vs 49.8 (49.3-50.2), P <0.001]. Language and physical barriers at scene were associated with EMS time delays [48.4 (47.3-49.6) vs 45.2 (44.8-45.6), P <0.001]. EMS times increased from urban to suburban, rural, and wilderness settings [42.6 (42.3-42.9) vs 48.6 (47.6-49.5) vs 50.5 (49.6-51.4) vs 62.4 (59.8-64.9), P <0.001]. Similarly, Pacific and Mid-Atlantic regions had faster EMS times compared to Mountain regions [35.2 (34.6-35.8) vs 36.5 (35.6-37.4) vs 46.6 (45.4-47.8), P <0.001]. Patients ≥65 years had less EMS times compared to those aged <65 years [44.9 (44.5-45.2) vs 46.9 (46.4-47.4), P <0.001]. Conclusion: EMS times in patients with acute stroke are influenced by multiple factors. A better understanding of modifiable and region specific factors can expedite time interval between symptom onset and treatment for acute stroke patients.

A National Assessment of Factors Influencing Emergency Medical Services Times among Acute Stroke Patients (P02.223)

Neurology ◽  
2012 ◽  
Vol 78 (Meeting Abstracts 1) ◽  
pp. P02.223-P02.223
Author(s):  
V. Jadhav ◽  
S. Pawar ◽  
S. Chaudhry ◽  
A. Hassan ◽  
G. Rodriguez ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Emergency Medical Services ◽  
Medical Services ◽  
Stroke Patients ◽  
National Assessment ◽  
Factors Influencing ◽  
Emergency Medical

scholarly journals Prehospital Triage of Acute Stroke Patients During the COVID-19 Pandemic

Stroke ◽  
2020 ◽  
Vol 51 (7) ◽  
pp. 2263-2267 ◽  
Author(s):  
Mayank Goyal ◽  
Johanna M. Ospel ◽  
Andrew M. Southerland ◽  
Charles Wira ◽  
Sepideh Amin-Hanjani ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Conceptual Framework ◽  
Emergency Medical Services ◽  
Stroke Patient ◽  
Medical Services ◽  
Acute Stroke Patient ◽  
Stroke Patients ◽  
Emergency Medical ◽  
The Future ◽  
Prehospital Triage

Abstract: The coronavirus disease 2019 (COVID-19) pandemic has broad implications on stroke patient triage. Emergency medical services providers have to ensure timely transfer of patients while minimizing the risk of infectious exposure for themselves, their co-workers, and other patients. This statement paper provides a conceptual framework for acute stroke patient triage and transfer during the COVID-19 pandemic and similar healthcare emergencies in the future.

scholarly journals Comparison of Emergency Medical Services Duration amid Routine Service for COVID-19 Patients

2021 ◽  
Vol 9 (E) ◽  
pp. 289-292
Author(s):  
Korakot Apiratwarakul ◽  
Takaaki Suzuki ◽  
Ismet Celebi ◽  
Kamonwon Ienghong ◽  
Thanat Tangpaisarn ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Operating Time ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Medical Services ◽  
Cross Sectional ◽  
Routine Service ◽  
Emergency Medical ◽  
Number Of Patients ◽  
The Mean

BACKGROUND: Concerning the COVID-19 outbreak in Thailand, the number of patients has been increasing. Emergency medical services (EMS) operating duration differs from normal services due to equipment preparation, number of personnel, and on-board ambulance procedures. Notably, there have been no studies examining EMS duration regarding COVID-19 patients. AIM: The aim of this study was to compare the EMS time for COVID-19 patients and routine services. METHODS: This cross-sectional study was conducted in a tertiary university hospital in Khon Kaen, Thailand. Information gathering was carried out by employing the Srinagarind Hospital EMS database throughout January 1, 2020, and February 10, 2021. RESULTS: A total of 2420 EMS operations were examined, of which five tested positive for COVID-19 (0.21%). The mean age of the COVID-19 patients was 35.6 ± 7.2 years, with the activation interval for COVID-19 and routine services at 64.20 ± 10.14 and 1.42 ± 0.42 min, respectively (p < 0.001). The on-scene time for COVID-19 and routine services was 3.20 ± 0.44 and 5.20 ± 2.20 min, respectively. CONCLUSIONS: EMS operating time amid the activation interval for COVID-19 patients was significantly longer than in the normal group. However, on-scene time for COVID-19 patients was less time than in normal operations.

scholarly journals Stroke patients care by the Senegal-National Emergency Medical Services: retrospective study over 18 months

2020 ◽  
Vol 10 (1) ◽  
pp. 28-32
Author(s):  
Marième Soda Diop-Sène ◽  
Ousmane Cissé ◽  
Khalifa Ababacar Mbaye ◽  
Rokhaya Diagne ◽  
Ahmadou Bamba Mbodji ◽  
...  
Keyword(s):  
Public Health ◽  
Emergency Medical Services ◽  
Public Health Problem ◽  
Medical Services ◽  
Major Public Health Problem ◽  
Stroke Patients ◽  
Emergency Medical ◽  
The Mean ◽  
Host Structure ◽  
National Emergency

ntroduction: Stroke according to the WHO (World Health Organization) is a sudden deficit of focal brain function with no apparent cause other than a vascular cause. It is a major public health problem. It is the first cause of motor disability, second cause of cognitive disability and third cause of mortality in the world. Material and method: It is a retrospective and descriptive study of a period of 18 months (January 1, 2016 to October 30, 2017) conducted in the national Emergency Medical Services of Dakar (Senegal). According to our study criteria, 343 patients were collected. Results: The mean age of the patients was 64.2 years (extremes of 17 and 104 years). Men represented 54.22% (sex ratio M/W 1.8). Dakar represented the main provenance of our patients (79.30%). Hypertension was the main risk factor (50%). Acute headaches were the main warning sign (13.41%). An echocardiography was performed in 59 patients; complete tachyarrhythmia by atrial fibrillation represented 30% of the ECG. The CT-scan was performed for 201 patients (61% of ischemic stroke, 37.5% hemorrhagic and 1.5% of transient ischemic attack). The medevac represented 53.93%. Transportation was made essentially by the emergency medical services; home interventions were the most represented. The mean time for intervention by the emergency medical services was 134.71 minutes. Fann Hospital was the main host structure (45.49%). The care (of the emergency medical services) included, among others, intubation (4.8%), monitoring, oxygen therapy, urinary catheter and medical treatment. We noticed 20.40% of deaths in our series, due essentially to neurological complications. Conclusion: Stroke is a major public health problem. Difficulties are sometimes encountered in the care and the research of an appropriate host structure. The purpose of the pre-hospital care is to intervene as soon as possible while making a clinic diagnosis by performing forthwith a brain CT-scan in order to optimize the care and improve the prognostic of stroke patients.

Socioeconomic Influence on Emergency Medical Services Utilization for Acute Stroke: Think Nationally, Act Locally

2021 ◽  
pp. 194187442110100
Author(s):  
Matthew E. Ehrlich ◽  
Bin Han ◽  
Michael Lutz ◽  
Mohsen Ghiasi Ghorveh ◽  
Yasmin Ali Okeefe ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Emergency Medical Services ◽  
Social Factors ◽  
Medical Services ◽  
Stroke Patients ◽  
Services Utilization ◽  
Factors Associated ◽  
Emergency Medical ◽  
Medical Services Utilization ◽  
Future Education

Background and Purpose: Rates of emergency medical services (EMS) utilization for acute stroke remain low nationwide, despite the time-sensitive nature of the disease. Prior research suggests several demographic and social factors are associated with EMS use. We sought to evaluate which demographic or socioeconomic factors are associated with EMS utilization in our region, thereby informing future education efforts. Methods: We performed a retrospective analysis of patients for whom the stroke code system was activated at 2 hospitals in our region. Univariate and logistic regression analysis was performed to identify factors associated with use of EMS versus private vehicle. Results: EMS use was lower in patients who were younger, had higher income, were married, more educated and in those who identified as Hispanic. Those arriving by EMS had significantly faster arrival to code, arrival to imaging, and arrival to thrombolytic treatment times. Conclusion: Analysis of regional data can identify specific populations underutilizing EMS services for acute stroke symptoms. Factors effecting EMS utilization varies by region and this information may be useful for targeted education programs promoting EMS use for acute stroke symptoms. EMS use results in more rapid evaluation and treatment of stroke patients.

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