scholarly journals Reorganisation of stroke care in prehospital emergency medical services: results through transformative learning

2021 ◽  
Keyword(s):  
Transformative Learning ◽  
Learning Process ◽  
Stroke Care ◽  
Time Interval ◽  
Stroke Patients ◽  
Operating Model ◽  
Emergency Medical ◽  
Dispatch Centre ◽  
Prehospital Emergency ◽  
Load And Go

Background: Rapid recanalisation is important when treating ischaemic stroke patients. In Finland, the reorganisation of the prehospital emergency medical system and the establishment of emergency medicine as an independent speciality occurred some years ago. These reforms offered the opportunity to develop new prehospital and in-hospital pathways for stroke patients. Methods: In this retrospective study, we examined the immediate impact of implementing a new operating model in prehospital stroke care. We introduced a modified “load-and-go” model using a transformative learning process. We observed the immediate effects of the reorganisation by comparing prehospital time intervals three months before and three months after the reorganisation. Results: The new operating model was implemented using a transformative learning process. There was an immediate reduction of 35.1% from 21.4 to 13.9 minutes (P < 0.001) in the median on-scene time and of 18.2% from 52.7 to 43.1 minutes (P < 0.05) in the median total time, i.e. the time interval between the alarm from the dispatch centre to patient hand-over to ED. Conclusion: By using a transformative learning process in implementing a modified load-and-go operation model in the EMS, we could immediately reduce median on-scene time and median total time in the treatment of acute stroke patients.

Prehospital Emergency Medical Services Departure Interval: Does Patient Age Matter?

2016 ◽  
Vol 31 (6) ◽  
pp. 608-613 ◽  
Author(s):  
Bruno Schnegg ◽  
Mathieu Pasquier ◽  
Pierre-Nicolas Carron ◽  
Bertrand Yersin ◽  
Fabrice Dami
Keyword(s):  
Response Time ◽  
Emergency Medical Services ◽  
Time Of Day ◽  
Medical Services ◽  
Time Interval ◽  
Patient Age ◽  
Emergency Medical ◽  
Patient Âgé ◽  
Prehospital Emergency ◽  
The Impact

AbstractIntroductionThe concept of response time with minimal interval is intimately related to the practice of emergency medicine. The factors influencing this time interval are poorly understood.ProblemIn a process of improvement of response time, the impact of the patient’s age on ambulance departure intervals was investigated.MethodThis was a 3-year observational study. Departure intervals of ambulances, according to age of patients, were analyzed and a multivariate analysis, according to time of day and suspected medical problem, was performed.ResultsA total of 44,113 missions were included, 2,417 (5.5%) in the pediatric group. Mean departure delay for the adult group was 152.9 seconds, whereas it was 149.3 seconds for the pediatric group (P =.018).ConclusionA statistically significant departure interval difference between missions for children and adults was found. The difference, however, probably was not significant from a clinical point of view (four seconds).SchneggB, PasquierM, CarronPN, YersinB, DamiF. Prehospital Emergency Medical Services departure interval: does patient age matter?Prehosp Disaster Med. 2016;31(6):608–613.

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.

scholarly journals The role of the emergency medical dispatch centre (EMDC) and prehospital emergency care safety: results from an incident report (IR) system

CJEM ◽  
2015 ◽  
Vol 17 (4) ◽  
pp. 411-419 ◽  
Author(s):  
Alberto Mortaro ◽  
Diana Pascu ◽  
Tamara Zerman ◽  
Enrico Vallaperta ◽  
Alberto Schönsberg ◽  
...  
Keyword(s):  
Emergency Care ◽  
Prehospital Care ◽  
Prehospital Setting ◽  
Prehospital Emergency Care ◽  
Incident Report ◽  
Emergency Medical Dispatch ◽  
Emergency Medical ◽  
Dispatch Centre ◽  
Prehospital Emergency

AbstractIntroductionThe role of the emergency medical dispatch centre (EMDC) is essential to ensure coordinated and safe prehospital care. The aim of this study was to implement an incident report (IR) system in prehospital emergency care management with a view to detecting errors occurring in this setting and guiding the implementation of safety improvement initiatives.MethodsAn ad hoc IR form for the prehospital setting was developed and implemented within the EMDC of Verona. The form included six phases (from the emergency call to hospital admission) with the relevant list of potential error modes (30 items). This descriptive observational study considered the results from 268 consecutive days between February and November 2010.ResultsDuring the study period, 161 error modes were detected. The majority of these errors occurred in the resource allocation and timing phase (34.2%) and in the dispatch phase (31.0%). Most of the errors were due to human factors (77.6%), and almost half of them were classified as either moderate (27.9%) or severe (19.9%). These results guided the implementation of specific corrective actions, such as the adoption of a more efficient Medical Priority Dispatch System and the development of educational initiatives targeted at both EMDC staff and the population.ConclusionsDespite the intrinsic limits of IR methodology, results suggest how the implementation of an IR system dedicated to the emergency prehospital setting can act as a major driver for the development of a “learning organization” and improve both efficacy and safety of first aid care.

scholarly journals The Effect of Prehospital Emergency Medical Transportation on the Care of Stroke Patients

2007 ◽  
Vol 18 (3) ◽  
pp. 78-85
Author(s):  
Takahiro Ouchi ◽  
Yoshiyuki Minowa ◽  
Kazunori Keira ◽  
Katsuki Ikeda ◽  
Yoshikazu Ito ◽  
...  
Keyword(s):  
Stroke Patients ◽  
Emergency Medical ◽  
Prehospital Emergency

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.

scholarly journals New Perspectives in Stroke Management: Old Issues and New Pathways

2021 ◽  
Vol 11 (6) ◽  
pp. 767
Author(s):  
Fabio Pilato ◽  
Rosalinda Calandrelli ◽  
Fioravante Capone ◽  
Michele Alessiani ◽  
Mario Ferrante ◽  
...  
Keyword(s):  
Time Window ◽  
Enhanced Recovery ◽  
Current Knowledge ◽  
Oral Anticoagulants ◽  
Chronic Phase ◽  
Stroke Care ◽  
New Drugs ◽  
Stroke Patients ◽  
Social Burden ◽  
Novel Approaches

Stroke is a leading cause of disability and death worldwide and social burden is huge in terms of disabilities, mortality and healthcare costs. Recently, in an acute stroke setting, renewed interest in disease-modifying therapies and novel approaches has led to enhanced recovery and the reduction of long-term disabilities of patients who suffered a stroke. In the last few years, the basic principle “time is brain” was overcome and better results came through the implementation of novel neuroimaging tools in acute clinical practice, allowing one to extend acute treatments to patients who were previously excluded on the basis of only a temporal selection. Recent studies about thrombectomy have allowed the time window to be extended up to 24 h after symptoms onset using advanced neuroradiological tools, such as computer tomography perfusion (CTP) and magnetic resonance imaging (MRI) to select stroke patients. Moreover, a more effective acute management of stroke patients in dedicated wards (stroke units) and the use of new drugs for stroke prevention, such as novel oral anticoagulants (NOACs) for atrial fibrillation, have allowed for significant clinical improvements. In this editorial paper, we summarize the current knowledge about the main stroke-related advances and perspectives and their relevance in stroke care, highlighting recent developments in the definition, management, treatment, and prevention of acute and chronic complications of stroke. Then, we present some papers published in the Special Issue “Clinical Research on Ischemic Stroke: Novel Approaches in Acute and Chronic Phase”.

scholarly journals Emergency physician’s dispatch by a paramedic-staffed emergency medical communication centre: sensitivity, specificity and search for a reference standard

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Victor Nathan Chappuis ◽  
Hélène Deham ◽  
Philippe Cottet ◽  
Birgit Andrea Gartner ◽  
François Pierre Sarasin ◽  
...  
Keyword(s):  
Reference Standard ◽  
Medical Systems ◽  
Operating Characteristics ◽  
First Line ◽  
Emergency Calls ◽  
Emergency Medical ◽  
Dispatch Centre ◽  
Second Tier ◽  
Low Sensitivity ◽  
Level Of Risk

Abstract Background Some emergency medical systems (EMS) use a dispatch centre where nurses or paramedics assess emergency calls and dispatch ambulances. Paramedics may also provide the first tier of care “in the field”, with the second tier being an Emergency Physician (EP). In these systems, the appropriateness of the decision to dispatch an EP to the first line at the same time as the ambulance has not often been measured. The main objective of this study was to compare dispatching an EP as part of the first line emergency service with the severity of the patient’s condition. The secondary objective was to highlight the need for a recognized reference standard to compare performance analyses across EMS. Methods This prospective observational study included all emergency calls received in Geneva’s dispatch centre between January 1st, 2016 and June 30th, 2019. Emergency medical dispatchers (EMD) assigned a level of risk to patients at the time of the initial call. Only the highest level of risk led to the dispatch of an EP. The severity of the patient’s condition observed in the field was measured using the National Advisory Committee for Aeronautics (NACA) scale. Two reference standards were proposed by dichotomizing the NACA scale. The first compared NACA≥4 with other conditions and the second compared NACA≥5 with other conditions. The level of risk identified during the initial call was then compared to the dichotomized NACA scales. Results 97′861 assessments were included. Overall prevalence of sending an EP as first line was 13.11, 95% CI [12.90–13.32], and second line was 2.94, 95% CI [2.84–3.05]. Including NACA≥4, prevalence was 21.41, 95% CI [21.15–21.67], sensitivity was 36.2, 95% CI [35.5–36.9] and specificity 93.2 95% CI [93–93.4]. The Area Under the Receiver-Operating Characteristics curve (AUROC) of 0.7507, 95% CI [0.74734–0.75397] was acceptable. Looking NACA≥5, prevalence was 3.09, 95% CI [2.98–3.20], sensitivity was 64.4, 95% CI [62.7–66.1] and specificity 88.5, 95% CI [88.3–88.7]. We found an excellent AUROC of 0.8229, 95% CI [0.81623–0.82950]. Conclusion The assessment by Geneva’s EMD has good specificity but low sensitivity for sending EPs. The dichotomy between immediate life-threatening and other emergencies could be a valid reference standard for future studies to measure the EP’s dispatching performance.

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