Abstract WP252: The Effect and Associated Factors of Dispatcher Recognition of Stroke: A Multicenter Observational Cohort Study

Introduction: Stroke patients recognized by dispatchers have an increased chance of receiving prehospital care with advanced life support and arrive at hospital earlier. There is limited research on factors associated with dispatcher recognition of stroke. This study aimed to: (1) understand the details of the dispatcher-caller communication among the calls for stroke patients, (2) identify factors associated with stroke recognition by dispatchers, and (3) evaluate the association between stroke recognition by dispatchers and stroke management. Methods: We conducted a multicenter retrospective study involving patients with stroke or transient ischemic stroke transported by the emergency medical service, and arriving at 9 hospitals in Taipei within 3 hours of symptom onset from January 1, 2013 to February 28, 2014. Patients were excluded if tape-recording data or prehospital management information were not available. Data of the enrolled patients were reviewed, including the tape recording of the dispatcher-caller communication, the type of dispatch determination, and patient characteristics. We used stroke dispatch determination as the surrogate for stroke recognition by dispatchers. Multivariable logistic regression was used to identify the factors associated with stroke dispatch determination. Results: A total of 507 patients were included. In approximately 50% of cases, callers were close family members. Ninety-one patients (17.9%) had stroke dispatch determination. After adjustment, stroke reported spontaneously, any one symptom included in the Cincinnati Prehospital Stroke Scale reported spontaneously, and dispatcher adherence to the protocol, were associated with stroke dispatch determination independently. Stroke dispatch determination was associated with receiving pre-arrival notification, shorter door-to-computed tomography time, and thrombolytic therapy. Conclusions: The sensitivity of recognizing stroke patients by dispatchers is suboptimal. Dispatchers should spend more time identifying stroke patients from those with frequently reported problems, by following the dispatch protocol. Recognition of stroke by dispatchers was associated with improved stroke care.

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Abstract TP245: Variance in Ems Run Times by Receiving Hospital for Stroke Patients in San Diego County

Stroke ◽

10.1161/str.51.suppl_1.tp245 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Amelia Kenner-brininger ◽

Lindsay Olson-Mack ◽

Lorraine Calzone ◽

Kristi L Koenig ◽

Thomas M Hemmen

Keyword(s):

Response Time ◽

San Diego ◽

Life Support ◽

Prehospital Care ◽

Advanced Life Support ◽

San Diego County ◽

Stroke Patients ◽

Transport Time ◽

Stroke Registry ◽

Few Data

Background: Emergency Medical Services (EMS) play an important role as initial providers after stroke. Few data are available that capture Stroke Receiving System and EMS response and transport data. We used a stroke registry from a community of 3.3 million residents, 18 stroke receiving centers, and 19 ground transporting advanced life support EMS agencies to evaluate EMS response time, scene time, and transport times. Our aim was to inform the stroke community about duration of EMS care and guide future prehospital interventions. Methods: We included all cases from the San Diego County Stroke Registry arriving by EMS with associated computer automated dispatch (CAD) record and base hospital record (BHR) from July 2017 through December 2018. Records were linked on the EMS incident number, reviewed for accuracy. We analyzed EMS response, scene, transport and total run times (enroute to arrival) by receiving hospital. Results: Between July 2017 and December 2018 2,376 EMS patients were transported to 18 hospitals. Volume per hospital ranged from 11 to 483 patients over the study period. Mean (±SD) response time was 7.0 (±3.7) minutes, range: 5.3 to 9.3 minutes between hospitals. Mean (±SD) scene time was 13.1 (±5.2) minutes, range: 10.5 to 15.0 minutes between hospitals. Transport time averaged 13.8 (±7.7) minutes, range: 8.3 to 23.8 minutes between hospitals (IQR=8.5-17.9). The mean (±SD) total EMS run time was 33.8 (±10.8) minutes, range: 26.4 to 44.9 minutes between hospitals (IQR=26.4-39.9). Conclusion: Only minor variations in EMS response and scene times were observed across the Stroke Receiving Centers. However, transport time showed greater variation and contributed to the differences in total EMS run times. Many systems had short transport times, limiting prehospital interventions. Next steps include studying factors contributing to transport time variation to inform prehospital care and triage decisions of possible stroke patients to optimize transport times.

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Abstract P293: Disparate Outcomes for Stroke Patients With Documented Substance Use Compared to Those Without Substance Use

Stroke ◽

10.1161/str.52.suppl_1.p293 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Leslie Corless ◽

Tamela L Stuchiner ◽

Cameron Garvin ◽

Alexandra C Lesko ◽

Elizabeth Baraban

Keyword(s):

Substance Use ◽

Patient Characteristics ◽

Stroke Care ◽

Stroke Patients ◽

Chi Square ◽

Stroke Treatment ◽

Discharge Disposition ◽

Healthcare Settings ◽

Medical Histories ◽

The Impact

Background: Few studies have shown the impact of substance use (SU) on treatment and outcomes of stroke patients. Research suggests stigma related to SU impacts patient experience in healthcare settings. In this study we assessed whether there were differences in patient characteristics and outcomes for stroke patients with SU compared to those with no substance use (NSU). Methods: Retrospective data from two Oregon hospitals included patients admitted with stroke diagnosis, 18 years or older, who discharged between October 2017 and May 2019. Patients with documented SU and specific SU type were compared to patients with NSU with regard to demographics, medical history, stroke subtypes, treatment, discharge disposition and length of stay (LOS). SU was defined as any documented abuse of alcohol (ETOH), methamphetamine (MA), cannabis, opiates, cocaine, benzodiazepines, and Methyl-enedioxy-methamphetamine (MDMA). Non parametric median tests and Pearson’s chi square tests were used. Results: Among 2,030 patients included in the analysis, 13.8% (n=280) were SU and 86.2% (n=1,750) were NSU. Patients with SU were significantly younger, median age (61 vs. 73, p <.001) and less were female (35.4% vs. 53.6%, p <0.001). Those with SU had lower prevalence of dyslipidemia (43.6% vs. 59.5%, p <0.001), AFIB (12.5% vs. 22.2%, p <0.001), and previous TIA (6.1% vs 10.8%, p=0.02), and more smoked (54.3% vs 13.3% p <0.001). More patients with SU arrived via transfer (38.4% vs 27.4%, p=.001). Fewer patients with SU expired or were discharged to hospice (8.9% vs 13.7%) and a greater percent left against medical advice (AMA) (3.2% vs 0.6%) (p<.001). When comparing specific SU types to NSU, all SU groups were younger, had similar medical histories and a greater proportion left AMA. Only MA users had differentiating stroke diagnoses with a higher percent of SAH (14.5% vs 5.6%) (p=.003) in addition to longer LOS (6 vs 4 days, p=.006). No differences were found in acute stroke treatment rates. Conclusion: Patients with SU were demographically different from the NSU population and did differentiate on some stroke care outcomes and processes, potentially indicating opportunities to address stigma around substance use to meet the needs of patients with both stroke and substance use.

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Pediatric Prehospital Care in Urban and Rural Areas

PEDIATRICS ◽

10.1542/peds.88.4.681 ◽

1991 ◽

Vol 88 (4) ◽

pp. 681-690 ◽

Cited By ~ 1

Author(s):

James S. Seidel ◽

Deborah Parkman Henderson ◽

Patrick Ward ◽

Barbara Wray Wayland ◽

Beverly Ness

Keyword(s):

Emergency Medical Services ◽

Rural Areas ◽

Urban Areas ◽

Pediatric Patients ◽

Life Support ◽

Prehospital Care ◽

Advanced Life Support ◽

Medical Services ◽

Care Providers ◽

Emergency Medical

There are limited data concerning pediatric prehospital care, although pediatric prehospital calls constitute 10% of emergency medical services activity. Data from 10 493 prehospital care reports in 11 counties of California (four emergency medical services systems in rural and urban areas) were collected and analyzed. Comparison of urban and rural data found few significant differences in parameters analyzed. Use of the emergency medical services system by pediatric patients increased with age, but 12.5% of all calls were for children younger than 2 years. Calls for medical problems were most common for patients younger than 5 years of age; trauma was a more common complaint in rural areas (64%, P = .0001). Frequency of vital sign assessment differed by region, as did hospital contact (P < .0001). Complete assessment of young pediatric patients, with a full set of vital signs and neurologic assessment, was rarely performed. Advanced life support providers were often on the scene, but advanced life support treatments and procedures were infrequently used. This study suggests the need for additional data on which to base emergency medical services system design and some directions for education of prehospital care providers.

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A Workplace-Based Observation Strategy to Assess Prehospital Care Delivery by Public Ambulances in Ukraine

Prehospital and Disaster Medicine ◽

10.1017/s1049023x19004138 ◽

2019 ◽

Vol 34 (s1) ◽

pp. s179-s180

Author(s):

Stanislav Gaievskyi ◽

Oleksandr Linchevskyy ◽

Colin Meghoo

Keyword(s):

Life Support ◽

Care Delivery ◽

Prehospital Care ◽

Advanced Life Support ◽

Cost Effective ◽

Financial Resources ◽

Successful Implementation ◽

Patient Privacy ◽

Patient Encounter ◽

Treatment Protocols

Introduction:Current methods to evaluate the delivery of urgent prehospital care often rely on inadequate surrogate measures or unreliable self-reported data. A workplace-based strategy may be feasible to assess the delivery of prehospital care by ambulances in selected populations.Aim:To perform a nationwide assessment of the psychomotor performance of public ambulance workers in Ukraine, we created a plan of workplace-based observation. We conducted a post-hoc analysis of this strategy to assess feasibility, strengths, and limitations for future use in assessing prehospital ambulance performance.Methods:With support from the Ministry of Health, we sent teams of trained observers to 30 ambulance substations across Ukraine. Using data collection tools on mobile devices, these observers accompanied Advanced Life Support ambulances on urgent calls for periods of 72 hours. We evaluated this program for collecting patient encounter data against the investment of time, personnel, and financial resources.Results:Over a two-month period, we directly observed 524 patient encounters by public ambulances responding to urgent calls at 30 ambulance substations across Ukraine. We employed 6 observers and 2 administrators over this time period. Collecting our observations required 2,160 person-hours at the ambulance substations. The total distance traveled to these sites was 11,375 kilometers. Project costs amounted to 37,000 USD, equating to 71 USD per observed patient encounter.Discussion:Workplace-based assessments are a cost-effective strategy to collect data on the delivery of prehospital care in select populations. This data can be useful for identifying the current state of EMS care delivered and evaluating compliance with established treatment protocols. Successful implementation depends on effective planning and coordination with a commitment of time, personnel, and financial resources. Issues of patient privacy, legal permission, and observer training must be considered.

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Changes in Stroke Patients’ Health-Seeking Behavior by COVID-19 Epidemic Regions: Data from the Korean Stroke Registry

Cerebrovascular Diseases ◽

10.1159/000519093 ◽

2021 ◽

pp. 1-9

Author(s):

Han-Yeong Jeong ◽

Eung-Joon Lee ◽

Min Kyoung Kang ◽

Ki-Woong Nam ◽

Jeonghoon Bae ◽

...

Keyword(s):

Intravenous Thrombolysis ◽

Patient Characteristics ◽

Stroke Care ◽

Health Seeking ◽

Stroke Patients ◽

Stroke Registry ◽

Care Services ◽

Health Seeking Behaviors ◽

Number Of Patients ◽

Using Data

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has led to changes in stroke patients’ healthcare use. This study evaluated changes in Korean stroke patients’ health-seeking behaviors and stroke care services using data from the Korean Stroke Registry (KSR). Methods: We reviewed data from patients with acute stroke and transient ischemic attack (TIA) during 2019 (before COVID-19 period) and 2020 (COVID-19 period). Outcomes included patient characteristics, time from stroke onset to hospital arrival, and in-hospital stroke pathways. Subgroup analyses were performed for an epidemic region (Daegu city and Gyeongsangbuk-do region, the D-G region). Results: The study included 1,792 patients from the pre-COVID-19 period and 1,555 patients from the COVID-19 period who visited hospitals that contribute to the KSR. During the COVID-19 period, the D-G region had two-thirds the number of cases (vs. the pre-COVID-19 period) and a significant decrease in the proportion of patients with TIA (9.97%–2.91%). Unlike other regions, the median onset-to-door time increased significantly in the D-G region (361 min vs. 526.5 min, p = 0.016), and longer onset-to-door times were common for patients with mild symptoms and who were in their 60s or 70s. The number of patients who underwent intravenous thrombolysis also decreased during the COVID-19 period, although the treatment times were not significantly different between the 2 periods. Discussion/Conclusion: Korean stroke patients in a COVID-19 epidemic region exhibited distinct changes in health-seeking behaviors. Appropriate triage system and public education regarding the importance of early treatment are needed during the COVID-19 pandemic.

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Abstract P288: Statin Prescription Patterns at Discharge among Ischemic Stroke Patients. The North Carolina Stroke Care Collaborative

Circulation ◽

10.1161/circ.125.suppl_10.ap288 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Anna Kucharska-Newton ◽

Emily O'Brien ◽

Paige Bennett ◽

Wayne Rosamond

Keyword(s):

North Carolina ◽

Ischemic Stroke ◽

Statin Therapy ◽

Stroke Care ◽

Prescribing Patterns ◽

Lipid Lowering ◽

Stroke Patients ◽

Total N ◽

Factors Associated ◽

Statin Prescription

Background: Current American Heart Association/American Stroke Association guidelines recommend in-hospital initiation of statin therapy for stroke patients at the time of hospitalization and at discharge. Nationwide data suggest that despite a favorable trend of increased prescribing of statins at discharge, the overall proportion of stroke patients discharged with statin therapy is significantly below the guideline recommendations. Study aim: To evaluate statin prescribing patterns at discharge for patients hospitalized for ischemic stroke in 56 North Carolina (NC) hospitals participating in the NC Stroke Care Collaborative (NCSCC). Methods: We used data on ischemic stroke admissions in 2008 through 2011 to hospitals affiliated with the NCSCC. Of the total n=39,345 stroke admissions, 23,643 (60%) were admissions for ischemic stroke, as ascertained from ICD-9 discharge codes. Excluded from analysis were stroke admissions that resulted in transfer to another hospital (n=346), patients on observation (n=105) and comfort care only (n=589), patients who died prior to discharge (n=926), those whose hospital visit did not result in admission (n=9), those missing information on statin prescription at discharge (n=3,402), and those with a documented reason for not prescribing statin therapy at discharge (n=675). The final sample size was 19,064 ischemic stroke events. Linear and logistic regression models were used to evaluate factors associated with statin prescribing patterns. Results: Documented statin prescription at discharge varied by age, with the highest proportion of prescriptions registered for stroke patients aged 56-65 years (86%). Statin prescribing at discharge was significantly (p<0.01) lower among patients< 56 years (81%) and those >65 years of age (77%). After adjusting for age, factors associated with low statin prescribing in this population were female gender, small hospital bedsize, academic affiliation of the hospital, and rural location of the hospital. Medical history of dyslipidemia and evidence of lipid lowering medication at admission were positive predictors of statin prescribing at discharge. Conclusions: We observed an age-dependent pattern of statin prescribing at discharge for patients in hospitals affiliated with the NCSCC. The lower proportion of hospitalized ischemic patients over 65 years of age that are discharged on statin therapy compared to those younger is consistent with reports from other studies. The relatively low proportion of patients younger than 56 years with statin prescription at discharge requires further investigation.

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Abstract 13104: Comparison of Patient Characteristics and Outcomes Between Adult Non-traumatic Out-of-hospital Cardiac Arrests With and Without Extracorporeal Cardiopulmonary Resuscitation - A Community-wide Evaluation

Circulation ◽

10.1161/circ.132.suppl_3.13104 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Patrick Chow-In Ko ◽

Nai-Kuan Chou ◽

Matthew Huei-Ming Ma ◽

Yu-Wen Chen ◽

Tzong-Luen Wang ◽

...

Keyword(s):

Life Support ◽

Cerebral Performance Category ◽

Advanced Life Support ◽

Patient Characteristics ◽

Spontaneous Circulation ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Hospital Arrival ◽

Advanced Airway ◽

Younger Age ◽

Bystander Cpr

Objectives: The outcome of patients after OHCA is poor. Return to spontaneous circulation (ROSC) dramatically decreases with the duration of CPR. Extracorporeal membrane oxygenation has been proposed to assist CPR (ECPR) in OHCA. This study was to investigate the effects and characteristics of ECPR for adult non-traumatic (ANT) OHCA versus Non-ECPR on a community-wide basis. Methods: A prospective four-year observational database collected from a community-wide OHCA web registry in an urban EMS (emergency medical services) was studied. The EMS ambulance teams were capable with advanced airway, intravenous (iv) fluid skills, basic and advanced life support and automated external defibrillator techniques. Outcomes included survival and cerebral performance category scale (CPC) at discharge. ANT OHCA with and without ECPR in emergency were compared by regression analysis including factors of patient, pre-hospital and hospital characteristics and outcomes. Results: Comparing OHCA receiving ECPR (n=79) to those without (n=959), ECPR group were younger (median age 56 vs 78 p<0.001) and had higher portion for men (89 vs 64% p<0;001), witnessed arrest (Wit) (60.8 vs 32.5% p<0.001), bystander CPR (BCPR) (53.2 vs 36.8% p=0.005), initial shockable rhythms (SR) (74.6 vs 12.2% p<0.001) and therapeutic hypothermia (TH) (22.8 vs 1.1%, p<0.001). They (EPCR vs non-ECPR) had no difference for prehospital time intervals (22.5 vs 23 min.), laryngeal mask airway treatment (55.7 vs 52.8%), EMS iv epinephrine (20.3 vs 15.5%), endotracheal intubation (6.3 vs 8.0%), prehospital ROSC (11.4 vs 6% p=0.09), and ROSC upon hospital arrival (10.1 vs 8.5%). Outcomes were better in ECPR for discharged survival (41 vs 7% p<0.001) and CPC 1or2 (20.8 vs 3.8% p<0.001). After adjusting for Wit, BCPR, SR, TH, age and sex, both survival (adjusted odds ratio: 3.6 [95% 2.0-6.6]) and good CPC 1or2 (adjusted OR: 2.9 [95% 1.2-6.9]) were still significantly higher in ECPR. Conclusions: In current emergency practice for ANT OHCA, ECPR tended to apply to patients of younger age, men, witnessed arrest, BCPR, and initially shockable rhythms regardless of positive ROSC upon hospital arrival, that can independently lead to higher survival and good neurological outcome compared to non-ECPR.

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On-line Medical Direction: A Prospective Study

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00041960 ◽

1995 ◽

Vol 10 (3) ◽

pp. 174-177 ◽

Cited By ~ 21

Author(s):

Richard C. Wuerz ◽

Gregory E. Swope ◽

C. James Holliman ◽

Gaspar Vazquez-de Miguel

Keyword(s):

Prospective Study ◽

Life Support ◽

Treatment Time ◽

Prehospital Care ◽

Advanced Life Support ◽

Base Station ◽

University Hospital ◽

Time Interval ◽

Prehospital Treatment ◽

On Line

AbstractObjectives:To determine the frequency with which physician, on-line medical direction (OLMD) [direct medical control] of prehospital care results in orders, to describe the nature of these orders, and to measure OLMD time intervals.Methods:Blinded, prospective study.Setting:A university hospital base-station resource center.Participants:Ten emergency physicians, 50 advanced life support providers.Interventions:Prehospital treatment was directed by both standing orders and OLMD physician orders. Independent observers recorded event times and the characteristics of OLMD.Results:Physician orders were given in 47 (19%) of the 245 study cases, and covered a variety of interventions, including many already authorized by standing orders. Mean OLMD radio time was four minutes (245 ± 216 seconds [sec]), and time from beginning of OLMD to hospital arrival averaged 12 minutes (718 ± 439 sec). Mean transport time in this system was 13 minutes.Conclusion:Despite detailed standing orders, OLMD results in orders for clinical interventions in 19% of cases. On-line medical direction requires about four minutes of physician time per call. This constituted about one-third of the potential field treatment time interval in this system. Thus, OLMD appears to play an important role in providing quality prehospital care.

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Emergency Medical Service in Rural Mountain Areas in Taiwan: A Nantou Mountain Areas Based Study

Hong Kong Journal of Emergency Medicine ◽

10.1177/102490791402100606 ◽

2014 ◽

Vol 21 (6) ◽

pp. 373-381 ◽

Cited By ~ 1

Author(s):

Sc Hung ◽

Yh Li ◽

Mc Chen ◽

Sw Lai ◽

Fc Sung ◽

...

Keyword(s):

Response Time ◽

Emergency Medical Service ◽

Medical Service ◽

Life Support ◽

Advanced Life Support ◽

Patient Characteristics ◽

Emergency Medical Technician ◽

Mountain Areas ◽

Emergency Medical ◽

The Mean

Background This study explored the emergency medical service (EMS) in rural mountain areas in Taiwan to establish the public health policies in rural mountain areas. Methods This was a retrospective study. Based on mission records available at 3 EMS branches in Ren-Ai and Sinyi townships of Nantou County, we evaluated dispatched status, patient characteristics, and pre-hospital emergency managements. Results From January to June 2011, a total of 765 EMS were dispatched from these 3 mountain branches. Each dispatched EMS team was consisted of one official emergency medical technician (EMT) with EMT II certificate (100%), and one (88.0%) or two (11.2%) volunteers as EMT I personnel. Most of missions were conducted in the daytime and peaked during 10am to 12pm. Patients were characterised with more men and elderly and predominant with non-traumatic medical complains (55.0%). Approximately 38.7% EMS patients required the advanced life support. Of these 3 mountain EMS branches, the mean response time was 15.3±16.9 minutes, the mean management time on site was 6.1±6.9 minutes and the mean transport time was 38.0±15.9 minutes. The response time and transportation time of EMS in rural mountain areas were relatively longer than that in urban towns in Taiwan. Conclusions The rural EMS is under the challenges of providing appropriate and adequate medical care. Each EMS team should be equipped with adequate emergency care facilities and well trained personnel. (Hong Kong j.emerg.med. 2014;21:373-381)

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Management and outcomes of pediatric patients transported by emergency medical services in a Canadian prehospital system

CJEM ◽

10.1017/s1481803500013312 ◽

2006 ◽

Vol 8 (01) ◽

pp. 6-12 ◽

Cited By ~ 27

Author(s):

Julie Richard ◽

Martin H. Osmond ◽

Lisa Nesbitt ◽

Ian G. Stiell

Keyword(s):

Emergency Medical Services ◽

Life Support ◽

Hospital Admissions ◽

Advanced Life Support ◽

Patient Characteristics ◽

High Rate ◽

Blood Glucose Monitoring ◽

Cardiac Monitoring ◽

Medical Services ◽

Emergency Medical

ABSTRACTObjectives:There is uncertainty around the types of interventions that are provided by emergency medical services (EMS) to children during prehospital transport. We describe the patient characteristics, events, interventions provided and outcomes of a cohort of children transported by EMS.Methods:This prospective cohort study was conducted in a city of 750 000 people with a 2-tiered EMS system. All children <16 years of age who were attended by EMS during a 6-month period were enrolled. Data were extracted from ambulance call reports and hospital charts, and analyzed using descriptive statistics.Results:During the study period there were 1377 pediatric EMS calls. Mean age was 8.2 years (standard deviation 5.4), and the most common diagnoses were trauma (44.9%), seizure (11.8%) and respiratory distress (8.8%). The ambulance return code wasUrgentin 7%,Promptin 57%,Deferrablein 8% andNot Transportedin 28%. Fifty-six percent received either an Advanced Life Support or Basic Life Support prehospital intervention. Common procedures included cardiac monitoring (20.0%), oxygen administration (19.8%), blood glucose monitoring (16.3%), spine board (12.2%), limb immobilization (11.1%) and cervical collar (10.0%). Uncommon procedures included administering medications intravenously (IV) (1.4%), bag-valve-mask ventilation (0.3%) and endotracheal intubation (0.1%). Seventy-eight percent of attempted IV lines were successful. Only 9.0% of EMS-transported children were admitted to hospital, and 2.2% were admitted to the intensive care unit.Conclusions:This first study of Canadian pediatric prehospital interventions shows a high rate of non-transport, and a low rate ofUrgenttransports and hospital admissions for children. Very few children receive prehospital airway management, ventilation or IV medications; consequently EMS personnel have little opportunity to maintain these pediatric skills in the field.

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