Abstract TP256: Ems Run Times by Weekday vs. Weekend For Stroke Patients in San Diego County

Stroke ◽  
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 ◽  
Response Times ◽  
San Diego County ◽  
Hospital Treatment ◽  
Transport Time ◽  
Hospital Arrival ◽  
Stroke Registry ◽  
Clinically Significant ◽  
Initial Responder

Background: Emergency Medical Services (EMS) is important as the initial responder, very little data examines EMS response and transport to hospital diagnosis. Understanding differences between weekday and weekend is informative for resource and staff planning. Using a countywide registry, we evaluated differences in EMS response times on weekdays and weekends and in-hospital treatment. Methods: We included EMS San Diego County Stroke Registry cases with a computer automated dispatch (CAD) and base hospital record (BHR) from July 2017 through December 2018; linked on EMS incident number. We analyzed EMS response, scene and transport time by weekday and weekend for all cases and cases with last known normal (LKN) to EMS enroute time < 6 hours. Hospital arrival to tPA and to embolectomy therapy (EVT) time was analyzed for this subgroup. Weekend was defined as Friday 1800 through Monday 0600. Results: Of 2,376 cases, 726 (30.6%) arrived during weekends. Weekend mean (±SD) response time was 6.7 (±3.4) minutes (min); 7.1 min (±3.9) on weekdays. Mean weekend scene time was 12.8 (±5.1) min, 13.2 (±5.3) min on weekdays (p=.18). Transport time was 13.2 (±7.6) min on weekends, 14.1 (±7.8) min on weekdays (p=.01). There were 1,190 cases with LKN to EMS enroute time < 6 hours, 379 arrived on weekends (31.8%). Mean (±SD) response time was 6.6 (±3.4) min on weekends, 7.2 (±3.9) min on weekdays; weekend scene time 12.1 (±4.5) min, weekday scene time 12.2 (±4.9); weekend transport time 12.2 (±6.6) min, weekday transport time 12.7 (±7.4) min. Of this group, 378 received tPA, 126 (33.3%) on the weekend. Mean (±SD) weekend arrival to tPA was 53.6 (±22.2) min; 56.0 (±32.1) min on weekdays (p=.39). 100 cases received EVT, 39 on a weekend. Mean (±SD) weekend arrival to EVT was 2.1 (±0.6) hours; weekdays 1.9 (±0.8) hours (p=.13). Conclusion: One in three patients arrived at the hospital on weekends. EMS response time and scene time did not differ, while transport time on the weekend was shorter, although this may not be clinically significant. This may be attributed to traffic volume and patterns during these times. However, among patients with shorter LKN time and patients receiving tPA no difference in EMS times was seen. Overall acute stroke transfer times did not differ across weekends and weekdays.

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

Stroke ◽  
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.

Abstract P651: Should I Stay or Go: Seeking Stroke Care During Covid-19

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Kathyrn J Libby ◽  
Linda Couts ◽  
Paige Schoenheit-Scott ◽  
Lindsay L Olson-Mack ◽  
Amelia Kenner Brininger ◽  
...  
Keyword(s):  
San Diego ◽  
Arrival Time ◽  
Stroke Care ◽  
Time Frame ◽  
San Diego County ◽  
Stroke Patients ◽  
Discharge Data ◽  
Hospital Arrival ◽  
The Impact ◽  
At Home

Introduction: On March 16, 2020 San Diego County implemented a stay at home order in response to COVID-19 pandemic; followed by the state of California instituting a shelter in place order. Locally, San Diego County’s stroke receiving centers (SRC) determined a 30% drop in stroke code activations between March-April 2020 compared to the same time in 2019 indicating a possible delay in seeking care. Utilizing discharge data, we sought to understand the impact of the stay at home order on the timeliness of seeking care. Hypothesis: We hypothesized an increase in last known normal (LKN) to hospital arrival time and a decrease in alteplase (tPA) and endovascular therapy (EVT) treatment rates between March 16-June 30 2020 compared to March 16-June 30 2019. Methods: AIS patients presenting to one of 16 SRC in San Diego County between March 16-June 30 in 2019 and 2020, discharged from the hospital or treated in the ED and transferred to another facility were included. Patients arriving as transfers from another facility were excluded. Results: In 2019, of 1,342 AIS cases LKN time was recorded for 85.6% of cases; of 1,092 cases in 2020 86.4% of cases had a LKN. Average LKN to arrival was 20.5 hours in 2019 and 32.4 hours in 2020 (p = .001, 95% CI [4.79, 18.93]). In 2019, 209 (15.6%) received tPA and 91 (6.8%) had EVT. In 2020, 144 (13.2%) received tPA and 75 (6.9%) had EVT. Odds that a case in 2019 received tPA was 1.21 times that of cases in 2020 (p=.09). Odds that a case in 2019 had EVT was .99 times that of cases in 2020 (p=.93). Conclusion: Ischemic stroke patients arriving between March 16-June 30, 2020 had a longer LKN to arrival time compared to the same time frame in 2019. The longer time to arrival may have been due to patients waiting longer to seek care, as anecdotal information from patients eluded to. The odds of receiving tPA or EVT treatment in 2020 compared to 2019 were not statistically significant. This may be due to patients experiencing acute symptoms accessing healthcare at the same rate in 2020 as 2019. Analysis of percent of patients arriving within 4 hours of LKN and average NIHSS are important next steps to determine this. Regardless, during a time of community crisis, it is important to broadcast community messaging focusing on the importance of seeking emergency care for stroke-like symptoms.

Emergency Medical Services Response Times to Motor Vehicle Crashes Increased over the Period 1987 to 2015

2018 ◽  
Author(s):  
Patrick Gravell
Keyword(s):  
Response Time ◽  
Emergency Medical Services ◽  
Arrival Time ◽  
Motor Vehicle ◽  
Response Times ◽  
Motor Vehicle Crashes ◽  
Hospital Arrival ◽  
The Past ◽  
Emergency Medical ◽  
The Individual

Emergency Medical Services (EMS) response time to motor vehicle crashes (MVC’s) have been studied to determine if reducing the individual components of EMS response time (notification, arrival at the crash scene, and hospital arrival) may affect survival rates. It has been proposed that a reduction to 1 and 15- minute EMS notification and arrival times at the crash would result in 1.84% and 5.2% fewer fatalities. The aim of this study was to analyze the changes in EMS response times (notification, arrival at the crash scene, and hospital arrival) over the past three decades, both individually and overall. An important change in the past three decades is the increased use of cellular phones. Therefore, we hypothesized that EMSnotification time would have decreased over the timeframe, yielding an overall decrease in EMS response time. Our data are based on the Fatal Accident Reporting System (FARS) using the variables: Time of Crash, EMS Notification Time, EMS Arrival Time, EMS Hospital Arrival Time. This gives a total of 248,981 valid cases following the implementation of our inclusion criteria and truncation of the dataset to the 99th percentile to eliminate unexplainable outliers. We computed the individual and overall median EMS response times for each year from 1987 to 2015. Additionally, we analyzed the response times based on four separate crash factors: weather, total vehicles involved, time of day, and state population density. From 1987 to 2015 the individual EMS response times changed; while notification time has decreased, the arrival at both crash scene and hospital have steadily increased, resulting in overall increased total EMS response time.

scholarly journals Response Times of Motorcycle Ambulances during the COVID-19 Pandemic

2020 ◽  
Vol 8 (T1) ◽  
pp. 526-529
Author(s):  
Korakot Apiratwarakul ◽  
Kamonwon Ienghong ◽  
Vajarabhongsa Bhudhisawasdi ◽  
Dhanu Gaysonsiri ◽  
Somsak Tiamkao
Keyword(s):  
Response Time ◽  
Response Times ◽  
Operation Time ◽  
Cross Sectional Study ◽  
Average Response Time ◽  
Transport Time ◽  
Cross Sectional ◽  
Normal Period ◽  
System Data ◽  
Information Database

BACKGROUND: Motorcycles (motorlance) are often deployed as ambulances to the scene of an emergency to reduce response time. The COVID-19 pandemic has affected emergency medical services (EMS) in Thailand in many respects, and this study was conducted to examine its effect on motorlance operation time. AIM: The aim of the study was to examine motorlance operation time during the COVID-19 pandemic in comparison to normal periods. METHODS: This cross-sectional study examined all EMS motorlance operations dispatched from Srinagarind Hospital (Thailand). Data were collected from the Srinagarind Hospital EMS operation database and hospital information database system. Data from June 1, 2018, to December 31, 2019 (normal period) were compared with those from January 13 to April 21, 2020 (COVID-19). RESULTS: Eight hundred seventy-one EMS operations were examined over two periods. Mean patient age during the COVID-19 pandemic was 41.5 ± 6.2 years, and 54.6% (n = 59) were male. Average response time was 6.20 ± 1.35 min during the normal period and 3.48 ± 1.01 min during the pandemic (p = 0.021). Transport time was also significantly shorter during the latter period (2.35 vs. 5.20 min). CONCLUSIONS: Motorlance response and transport time during the COVID-19 pandemic were significantly shorter than usual.

Abstract WP295: Factors Influencing Ems Transport Time for Patients After Stroke in San Diego County

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Amelia Kenner-Brininger ◽  
Lindsay Olson-Mack ◽  
Lorraine Calzone ◽  
Kristi L Koenig ◽  
Thomas L Hemmen
Keyword(s):  
San Diego ◽  
Life Support ◽  
Advanced Life Support ◽  
San Diego County ◽  
Stroke Patients ◽  
Transport Time ◽  
Policy Makers ◽  
Stroke Diagnosis ◽  
Stroke Center ◽  
To Receive

Background: Emergency Medical Services (EMS) play an important role as initial providers to stroke patients. Data of on scene and transport times for stroke patients with unbiased populations are rare. We explored the range of times for stroke patients to receive care on scene and transport to a stroke receiving center (SRC) in a region with 3.3 million residents, 18 SRCs and 19 ground transport advanced life support EMS agencies. This will inform researchers on prehospital stroke invervention and policy makers deliberating triage and stroke center designation. Methods: We included all patients with final hospital diagnosis of AIS, ICH, SAH, or TIA transported by EMS to a San Diego County SRC between July 2017 and December 2018 with computer automated dispatch record and base hospital record. Records were linked on EMS incident number, reviewed for accuracy. We analyzed scene and transport time, weekday vs. weekend, last known normal (LKN) to EMS enroute < 6 hours (approximation of LKN to 911 call), EMS recognition of stroke, and final hospital diagnosis. Results: In total, 2,376 patients with final stroke diagnosis were transported between July 2017 and December 2018. In 1,514 (63.7%) cases, EMS recognized stroke. In these cases mean (±SD) scene time was 12.0 (±4.6) minutes and transport time 12.4 (±7.2). In stroke patients without EMS stroke recognition the mean (±SD) scene time was 14.8 (±5.7) (p=.0001) and transport time of 16.2 (±8.1) (p=.0001). Scene time (p=.002), EMS stroke recognition (p=.00001), weekend vs. weekday (p=.013), LKN to enroute < 6 hours (p=.00001) were all correlated with shorter transport time; hospital stroke diagnosis (p=.56) was not. Linear regression indicated LKN to enroute < 6 hours (p=.001) and EMS stroke recognition (p=.00001) were significant in determining shorter transport time. Conclusion: EMS transport time of stroke patients varies across our system. However, when EMS providers recognize a stroke patient, scene time decreases by nearly 3 minutes and transport time decreases by nearly 4 minutes compared with patients with stroke undetected until after hospital arrival. Additionally, patients with a shorter LKN to EMS enroute time have a shorter transport time, which may be clinically important for this time-sensitive condition.

Abstract WMP120: Does ICH Volume Affect Onset to Arrival Time?

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Dawn Meyer ◽  
Lovella Hailey ◽  
Melissa Mortin ◽  
David Nguyen ◽  
Mohshen Pirastehfar ◽  
...  
Keyword(s):  
Symptom Onset ◽  
San Diego ◽  
Primary Diagnosis ◽  
Demographic Variables ◽  
Time Of Arrival ◽  
Hematoma Volume ◽  
Hospital Arrival ◽  
Stroke Registry ◽  
History Of ◽  
Baseline Demographic

Background: ICH is a disease of high mortality. Increased hematoma volume has been associated with increased NIHSS severity and worse outcome. The purpose of this study was to determine if hematoma volume was correlated with time from symptom onset to time of hospital arrival. Methods: We conducted a review of consecutive acute ICH patients who were treated at UC San Diego from an IRB approved, prospectively collected UC San Diego Stroke Registry (1/2003-07/2016). All patients that presented as a “code stroke” within 12 hours and had ICH as the primary diagnosis were included in the analysis. Patients were allocated to time quartiles from symptom onset to arrival and compared between those quartiles for baseline demographic variables. A correlation matrix was built to assess variables that were correlated with ICH volume (mL). Variables with a p >0.10 were then included in a logistic regression to model. Results: The overall sample included 316 patients. Time from onset to arrival ranged from 25-720 minutes. The baseline demographics were significantly different amongst the time quartiles for: 1) history of atrial fibrillation (p=0.04); 2) current alcohol use (0.04); 3) and NIHSS (p=0.006). Patient in Q3 had the highest a-fib rates (20.5%). NIHSS was highest in Q1. ICH volume was significantly and positively correlated with age, history of HTN, current ETOH abuse, current SBP, and 90 day mRS (all p<0.05). ICH volume was not significantly correlated with time of arrival. Conclusion: This study supports the previous data of ICH volumes relationships to outcome. Other variables may be considered in ICH outcome scales to improve prognosis.

scholarly journals Geographical Distribution of Emergency Services Times in Traffic Accidents in Extremadura

2021 ◽  
pp. 1-10
Author(s):  
José Antonio Morales-Gabardino ◽  
Laura Redondo-Lobato ◽  
João Meireles Ribeiro ◽  
Francisco Buitrago
Keyword(s):  
Response Time ◽  
Urban Areas ◽  
Traffic Accidents ◽  
Emergency Services ◽  
Response Times ◽  
Geographical Location ◽  
Transport Time ◽  
Cross Sectional ◽  
Peripheral Areas ◽  
Accident Scene

<b><i>Objective:</i></b> To analyze the response time and transport time taken by the emergency medical services (EMS), considering their urban or rural location, to attend traffic accident casualties that occurred in the different geographical areas of Extremadura (Spain) from 2012 to 2015. <b><i>Methods:</i></b> This was a cross-sectional study of the data recorded by the Emergency Response Coordination Center 112 (ERCC-112) from traffic accidents attended by EMS. Response time was defined as the time elapsed from the request-for-care receipt until arrival of the EMS at the accident scene, and transport time as that from leaving the scene until arrival to the referral hospital. Rural EMS were those based in locations where there is no hospital, and urban EMS those located in towns or cities with a hospital. <b><i>Results:</i></b> During the 4-year period studied, 5,572 traffic accidents requested assistance through the ERCC-112. From the 2,875 accidents (51.9%) in which EMS were mobilized, 55.4% occurred in urban roads and the remaining in interurban ones. A total of 113 people (mean age 48.4 ± 19.0 years, range 15–84 years) died at the accident scene or before arrival to the hospital, 88.5% of them in interurban accidents. The average response time of urban and rural EMS was 10.7 ± 7.3 and 18.0 ± 12.6 min (<i>p</i> &#x3c; 0.001), respectively, and the average transport time was 13.2 ± 11.7 and 45.2 ± 25.0 min (<i>p</i> = 0.009). Response time was longer than the 30-min optimum only in the most peripheral areas of Extremadura, while transport time exceeded the optimum of 90 min in the eastern regions of two health areas (Cáceres and Don Benito-Villanueva). 19.1% of the victims attended by rural EMS were classified as having a serious prognosis or as having died, as compared with 11.2% (<i>p</i> = 0.048) of those attended by urban EMS. <b><i>Conclusions:</i></b> The geographical location of EMS in Extremadura (Spain) guarantees adequate response times in traffic accidents, both in rural and urban areas. However, recommended transport times were occasionally exceeded in the most peripheral areas, due to hospital location.

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