Abstract WP470: Stroke’s Pathways of Patients Transported by Advanced Life Support Ambulance: A 26 Years Registry

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Anna Ozguler ◽  
Michel Baer ◽  
Jeremie Boutet ◽  
Adrien Altar ◽  
Thomas Loeb
Keyword(s):  
Medical Service ◽  
Life Support ◽  
Age Groups ◽  
Care Facility ◽  
Advanced Life Support ◽  
Older Age ◽  
Radiology Department ◽  
Stroke Patients ◽  
Stroke Units ◽  
Paris Area

Introduction: Since mid-2000, stroke guidelines were revised and 18 stroke units (SU) settled in Paris area (France). Our Emergency Medical Service (EMS) in a catchment of 500 000 inhabitants registered all acute strokes where dispatch of an Advanced Life Support (ALS) ambulance was decided since 1993. Methods: Data were collected from an EMS registry (1993-2019). The study included patients 16 years old and over, with an acute stroke requiring an ALS ambulance. Collected data were gender, age (by quartile), time periods (1993-99, 2000-04, 2005-09, 2010-14, 2015-19) and receiving care facility: SU, neurosurgery, intensive care unit (ICU), emergency department (ED), radiology department (MRI or scanner) or left on scene (LOS dead or alive). Comparisons were performed with Chi-2 test. Results: This study included 2955 stroke patients, mean age was 70.7 years old, sex ratio was 0.93. Table 1 and graphic 1 results show the emergence of SU during mid-2000, with a decrease of ED transfers, while neurosurgery and ICU remained steady (p<10 -3 ). This decrease of ED was more important for older age groups (≥ 75 years old). Conclusion: Older age groups benefitted more from specialized pathways including ICU and SU, with less transports to ED, but never clearly from neurosurgery. Development of SU probably explains the decreased number of younger patients in neurosurgery. Literature shows that direct pathway to SU significantly improved prognosis of stroke patients. This registry of ALS transports shows its growing use in EMS dispatch, as for ST+ myocardial infarction, while transports to ED decrease. It would be interesting to compare these results with those of faster Basic Life Support transports.

scholarly journals Prehospital Time of Suspected Stroke Patients Treated by Emergency Medical Service: A Nationwide Study in Thailand

2020 ◽  
Author(s):  
Phantakan Tansuwannarat ◽  
Pongsakorn Atiksawedparit ◽  
Arrug Wibulpolprasert ◽  
Natdanai Mankasetkit
Keyword(s):  
Emergency Medical Service ◽  
Medical Service ◽  
Life Support ◽  
Demographic Data ◽  
Advanced Life Support ◽  
National Database ◽  
Stroke Patients ◽  
Emergency Medical ◽  
Suspected Stroke ◽  
Prehospital Time

Abstract Background: This study was to study the prehospital time among suspected stroke patients who were transported by emergency medical service (EMS) system using national database. Methods: National EMS database across 77 provinces of Thailand among suspected stroke patients who were treated by EMS system between January 1, 2015 to December 31, 2018 was retrospectively analyzed. Demographic data (i.e., regions, shifts, levels of ambulance and distance to scene) and prehospital time (i.e., dispatch, activation, response, scene and transportation times) were extracted. Time parameters were also categorized according to guideline. Results: In total 53,536 subjects were included in analysis. Most of the subjects were transported during 06.00-18.00 and were in 10 kilometers from ambulance parking. Half of the subjects were treated by advanced life support (ALS) ambulance. Median total time was 29 minutes (IQR: 21, 39) which was mainly occupied for transporting patient from scene to hospital. Although most of subjects had dispatch and activation times ≤ 2 minutes, but only 48.3% had RT ≤ 8 minutes. However, 95% of service were at scene ≤ 15 minutes. ALS ambulance had the longer total time, compared to first responder and basic level (30 minutes versus 28 and 27 minutes). Conclusions: Prehospital time from EMS call to hospital was approximately 30 minutes among suspected stroke patients. This was mainly utilized for travelling from ambulance parking to scene and transporting patient from scene to hospital. Although only 48% of services had RT ≤ 8 minutes, but 95% of them had scene time ≤ 15 minutes.

scholarly journals Prehospital time of suspected stroke patients treated by emergency medical service: a nationwide study in Thailand

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Phantakan Tansuwannarat ◽  
Pongsakorn Atiksawedparit ◽  
Arrug Wibulpolprasert ◽  
Natdanai Mankasetkit
Keyword(s):  
Emergency Medical Service ◽  
Medical Service ◽  
Life Support ◽  
Demographic Data ◽  
National Database ◽  
Stroke Patients ◽  
Emergency Medical ◽  
Significant Difference ◽  
Suspected Stroke ◽  
Prehospital Time

Abstract Background This work was to study the prehospital time among suspected stroke patients who were transported by an emergency medical service (EMS) system using a national database. Methods National EMS database of suspected stroke patients who were treated by EMS system across 77 provinces of Thailand between January 1, 2015, and December 31, 2018, was retrospectively analyzed. Demographic data (i.e., regions, shifts, levels of ambulance, and distance to the scene) and prehospital time (i.e., dispatch, activation, response, scene, and transportation time) were extracted. Time parameters were also categorized according to the guidelines. Results Total 53,536 subjects were included in the analysis. Most of the subjects were transported during 06.00-18.00 (77.5%) and were 10 km from the ambulance parking (80.2%). Half of the subjects (50.1%) were served by advanced life support (ALS) ambulance. Median total time was 29 min (IQR 21, 39). There was a significant difference of median total time among ALS (30 min), basic (27 min), and first responder (28 min) ambulances, Holm P = 0.009. Although 91.7% and 88.3% of the subjects had dispatch time ≤ 1 min and activation time ≤ 2 min, only 48.3% had RT ≤ 8 min. However, 95% of the services were at the scene ≤ 15 min. Conclusion Prehospital time from EMS call to hospital was approximately 30 min which was mainly utilized for traveling from the ambulance parking to the scene and transporting patients from the scene to hospitals. Even though only 48% of the services had RT ≤ 8 min, 95% of them had the scene time ≤ 15 min.

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 35: Dispatcher Impression of Stroke: Concordance With Paramedic Identification and Effect on Allocation of Standard Ambulances and Mobile Stroke Units

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
May Nour ◽  
Clayton Kazan ◽  
Nicole Steeneken ◽  
Kevin M Brown ◽  
Bryan Villareal ◽  
...  
Keyword(s):  
High Risk ◽  
Positive Predictive Value ◽  
Basic Life Support ◽  
Life Support ◽  
Altered Mental Status ◽  
Patient Assessment ◽  
Stroke Patients ◽  
Stroke Units ◽  
Fire Stations ◽  
Almost All

Background: EMS 911 dispatchers must rapidly assess patient calls and allocate appropriate responding resources including, for stroke, advanced (rather than basic) life support standard ambulances and, in an increasing number of regions, specialty Mobile Stroke Units. While dispatcher accuracy in distinguishing stroke from other high risk conditions is not crucial for selecting ALS rather than BLS response, specialized MSU response necessitates a higher level of accuracy. Methods: We analyzed all transports between January 2018-August 2019 identified as stroke by dispatchers at sendout or by paramedics upon patient assessment in a large urban EMS system -LA County FD EMS, serving 4.1 million lives, 59 cities, 3,000 square miles, via 174 fire stations. Dispatchers are instructed to decide upon the appropriate diagnosis and responding resource within 60s of start of 911 call conversation. “Dispatcher Impression” (DI) and on scene paramedic “Provider Impression” (PI) were compared, and other care metrics analyzed. Results: In total, 12,528 runs were evaluated, of which 79.1% (9913) were dispatched as stroke and paramedics identified stroke in 47.6%. The sensitivity of dispatcher impression of stroke was 56.2% and the positive predictive value was 33.9%. The most common paramedic impressions in non-concordant patients dispatched as stroke were: generalized weakness in 24% (1587), altered mental status in 17% (1111), and syncope in 6% (403). In patients with a dispatcher impression of non-stroke but paramedic impression of stroke, the most common dispatcher impressions were: sick person in 29% (758), unconscious in 28.7% (750), and seizure in 4.6% (121). In dispatcher impressions of stroke, 100% were dispatched at ALS level; and in dispatcher impressions of non-stroke but eventual paramedic impression of stroke, 98.3% were dispatched at ALS level. Patient age over/under 40 & patient sex did not modify rates of dispatcher - paramedic impression concordance. Conclusions: Dispatchers identify more than half of paramedic-identified stroke patients and allocate appropriate ALS standard ambulances in almost all stroke patients. However, for efficient attaching of specialized MSU resources, improved dispatcher identification of stroke is desirable.

Age-related Utilization of Advanced Life Support Services

1991 ◽  
Vol 6 (1) ◽  
pp. 9-14 ◽  
Author(s):  
Steven A. Meador
Keyword(s):  
Life Support ◽  
Age Groups ◽  
Rank Correlation ◽  
Advanced Life Support ◽  
The Elderly ◽  
Population Projections ◽  
Patient Treatment ◽  
Related Case ◽  
Spearman’S Rank Correlation ◽  
Age Related

AbstractPurpose:To investigate the relationship between age and Advanced Life Support (ALS) utilization.Population:All patients from 1 January 1987 to 31 December 1988 transported by ALS ambulances within Lebanon County, a rural/urban county of 112,000.Methods:All runs resulting in patient treatment by ALS personnel were tallied at five-year age intervals and sub-grouped by trauma- and non-trauma-related calls. Utilization rates for each age group were obtained by dividing the calls by the population of each group. Correlation with age was tested by Spearman's rank correlation. Treatment rates for age groups were calculated for the six most frequent medical etiologies. To illustrate the effect of age distributions, age rates were applied to projected state and national population distributions.Results:There was a significant correlation with age for all transports (p < .01; r=.93) and for those not related to trauma (p<.01; r=.98). Correlation was not detected for trauma-related responses (p>.10; r=.19). Non-trauma-related case incidence varied among age groups, ranging from 1.1/1,000 for age five through nine years to 89/1,000 for age 80–84 years. Congestive heart failure, cardiac ischemia, syncope, myocardial infarction, and cardiac arrest evidenced increased incidence with age. Seizure did not. Older populations had a higher projected utilization of ALS services than did the younger age groups.Conclusion:Non-trauma ALS utilization is highly dependent on the age of the patient. Due to projected aging of the population and increased utilization of ALS by the elderly, projected utilization will increase at a rate faster than will the population. Age:rate data can be combined with population projections to estimate future need.

scholarly journals South African paramedic perspectives on prehospital palliative care

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Caleb Hanson Gage ◽  
Heike Geduld ◽  
Willem Stassen
Keyword(s):  
Higher Education ◽  
Palliative Care ◽  
South African ◽  
Medical Service ◽  
Life Support ◽  
Healthcare Providers ◽  
Advanced Life Support ◽  
Early Palliative Care ◽  
Audio Recordings ◽  
Valuable Role

Abstract Background Palliative care is typically performed in-hospital. However, Emergency Medical Service (EMS) providers are uniquely positioned to deliver early palliative care as they are often the first point of medical contact. The aim of this study was to gather the perspectives of advanced life support (ALS) providers within the South African private EMS sector regarding pre-hospital palliative care in terms of its importance, feasibility and barriers to its practice. Methods A qualitative study design employing semi-structured one-on-one interviews was used. Six interviews with experienced, higher education qualified, South African ALS providers were conducted. Content analysis, with an inductive-dominant approach, was performed to identify categories within verbatim transcripts of the interview audio-recordings. Results Four categories arose from analysis of six interviews: 1) need for pre-hospital palliative care, 2) function of pre-hospital healthcare providers concerning palliative care, 3) challenges to pre-hospital palliative care and 4) ideas for implementing pre-hospital palliative care. According to the interviewees of this study, pre-hospital palliative care in South Africa is needed and EMS providers can play a valuable role, however, many challenges such as a lack of education and EMS system and mindset barriers exist. Conclusion Challenges to pre-hospital palliative care may be overcome by development of guidelines, training, and a multi-disciplinary approach to pre-hospital palliative care.

Recommended Guidelines for Uniform Reporting of Pediatric Advanced Life Support: The Pediatric Utstein Style

PEDIATRICS ◽  
1995 ◽  
Vol 96 (4) ◽  
pp. 765-779 ◽  
Author(s):  
Arno Zaritsky ◽  
Vinay Nadkarni ◽  
Mary Fran Hazinski ◽  
George Foltin ◽  
Linda Quan ◽  
...  
Keyword(s):  
Life Support ◽  
Task Force ◽  
Age Groups ◽  
Advanced Life Support ◽  
Data Set ◽  
Consensus Document ◽  
Eastern Virginia Medical School ◽  
Pediatric Resuscitation ◽  
Recommended Guidelines

This consensus document is an attempt to provide an organized method of reporting pediatric ALS data in out-of-hospital, emergency department, and in-hospital settings. For this methodology to gain wide acceptance, the task force encourages development of a common data set for both adult and pediatric ALS interventions. In addition, every effort should be made to ensure that consistent definitions are used in all age groups. As health care changes, we will all be challenged to document the effectiveness of what we currently do and show how new interventions or methods of treatment improve outcome and/or reduce cost. Only through collaborative research will we obtain the necessary data. For these reasons, and to improve the quality of care and patient outcomes, it is the hope of the task force that clinical researchers will follow the recommendations in this document. It is recognized that further refinements of this statement will be needed; these recommendations will improve only when researchers, clinicians, and EMS personnel use them, work with them, and modify them. Suggestions, emendations, and other comments aimed at improving the reporting of pediatric resuscitation should be sent to Arno Zaritsky, MD, Eastern virginia Medical School, Children's Hospital of The King's Daughter, Division of Critical Care Medicine, 601 Children's Lane, Norfolk, VA 23507.

Abstract 351: Predictors of Neurological Outcome After Out-of-Hospital Cardiac Arrest With Ventricular Fibrillation Witnessed by Emergency Medical Service P.ersonnel., JCS-ReSS Study

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Katsutaka Hashiba ◽  
Yoshio Tahara ◽  
Kazuo Kimura ◽  
Tsutomu Endo ◽  
Kouichi Tamura ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Airway Management ◽  
Neurological Outcome ◽  
Medical Service ◽  
Life Support ◽  
Advanced Life Support ◽  
Advanced Airway ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Background: Effective advanced life support is one of the important link in the chain of survival. In Japan, the emergency medical service (EMS) personnel can perform defibrillation, advanced airway management, intravenous access and administration of epinephrine as an advanced life support intervention for the treatment of out-of-hospital cardiac arrest (OHCA). However, whether these interventions performed by EMS improves neurological outcomes remains unclear. Objective: To evaluate predictors of favorable neurological outcome in patients suffering OHCA with ventricular fibrillation (VF) witnessed by an EMS personnel. Methods: The Fire and Disaster Management Agency (FDMA) of Japan developed a nationwide database of a prospective population-based cohort using an Utstein-style template for OHCA patients since January 2005. To evaluate data after the publication of Guideline2010, data from January 2011 to December 2015 of this database was used for the current analysis. A multivariate logistic-regression analysis was performed to assess factors associated with favorable neurological outcome (defined as Cerebral Performance Category 1 or 2) 1 month after cardiac arrest. Results: Of the 629,471 patients documented for the study period, 2,301 adult patients with an OHCA of cardiac origin and VF for the initial rhythm witnessed by an EMS personnel were included in the present analysis. The overall mortality was 49.6%. Rate of return of spontaneous circulation and favorable neurological outcome were 53.4% and 44.8%, respectively. High age (OR0.387, 95%CI0.316-0.472, p<0.001), delayed defibrillation (OR0.598, 95%CI0.493-0.723, p<0.001), advanced airway management (OR0.305, 95%CI0.223-0.413, p<0.001), administration of epinephrine (OR0.356, 95%CI0.213-0.585, p<0.001) and multiple attempts of defibrillation (OR0.484, 95%CI0.402-0.582, p<0.001) were negatively associated with favorable neurological outcome. Conclusion: In patients with VF witnessed by EMS personnel, resuscitation efforts should simply focus on early defibrillation and CPR without advanced interventions.

scholarly journals Factors Associated with High-Quality Cardiopulmonary Resuscitation Performed by Bystander

2020 ◽  
Vol 2020 ◽  
pp. 1-6 ◽  
Author(s):  
Hye Ji Park ◽  
Won Jung Jeong ◽  
Hyung Jun Moon ◽  
Gi Woon Kim ◽  
Jin Seong Cho ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Age Groups ◽  
Sudden Cardiac Arrest ◽  
Advanced Life Support ◽  
Fold Increase ◽  
High Quality ◽  
Neurological Outcomes ◽  
Bystander Cpr ◽  
Cpr Quality

Bystander cardiopulmonary dresuscitation (CPR) improves the survival and neurological outcomes of sudden cardiac arrest patients. The rate of bystander CPR is increasing; however, its performance quality has not been evaluated in detail. In this study, emergency medical technicians (EMTs) in the field evaluated bystander CPR quality, and we aimed to investigate the association between bystander information and CPR quality. This retrospective cohort study was based on data included in the Smart Advanced Life Support (SALS) registry between January 2016 and December 2017. We included patients older than 18 years who experienced an out-of-hospital cardiac arrest (OHCA) due to medical causes. Bystander CPR quality was judged to be “high” when the hand positions were appropriate and when compression rates of at least 100/min and compression depths of at least 5 cm were achieved. Among 6,769 eligible patients, 3,799 (58.7%) received bystander CPR, and 6% of bystanders performed high-quality CPR. After adjustment, the occurrence of cardiac arrest at home (adjusted odds ratio (aOR), 95% confidence interval (CI); 0.42, 0.27–0.64), witnessed cardiac arrest (1.45, 1.03–2.06), and younger bystander age all showed associations with one another. High-quality CPR led to a 4.29-fold increase in the chance of neurological recovery. In particular, high-quality CPR in patients aged 60 years showed a significant association compared with other age groups (7.61, 1.41–41.04). The main factor affecting CPR quality in this study was the age of the bystander, and older bystanders found it more difficult to maintain CPR quality. To improve the quality of bystander CPR, training among older bystanders should be the focus.

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

2014 ◽  
Vol 21 (6) ◽  
pp. 373-381 ◽  
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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