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

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.

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

Stroke ◽

10.1161/str.48.suppl_1.tp250 ◽

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.

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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 ◽

10.1161/str.45.suppl_1.wp187 ◽

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.

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Emergency medical services evaluations for chest pain during first COVID-19 lockdown in Hollands-Midden, the Netherlands

Netherlands Heart Journal ◽

10.1007/s12471-021-01545-y ◽

2021 ◽

Vol 29 (4) ◽

pp. 224-229 ◽

Cited By ~ 1

Author(s):

E. R. de Koning ◽

M. J. Boogers ◽

J. Bosch ◽

M. de Visser ◽

M. J. Schalij ◽

...

Keyword(s):

Chest Pain ◽

Emergency Medical Services ◽

Medical Services ◽

Cardiac Symptoms ◽

Emergency Medical ◽

Time Period ◽

Number Of Patients ◽

St Elevation ◽

Pain Patients ◽

Hospital Cardiac Arrest

Abstract Objective To assess whether the COVID-19 lockdown in 2020 had negative indirect health effects, as people seem to have been reluctant to seek medical care. Methods All emergency medical services (EMS) transports for chest pain or out-of-hospital cardiac arrest (OHCA) in the Dutch region Hollands-Midden (population served > 800,000) were evaluated during the initial 6 weeks of the COVID-19 lockdown and during the same time period in 2019. The primary endpoint was the number of evaluated chest pain patients in both cohorts. In addition, the number of EMS evaluations of ST-elevation myocardial infarction (STEMI) and OHCA were assessed. Results During the COVID-19 lockdown period, the EMS evaluated 927 chest pain patients (49% male, age 62 ± 17 years) compared with 1041 patients (51% male, 63 ± 17 years) in the same period in 2019, which corresponded with a significant relative risk (RR) reduction of 0.88 (95% confidence interval (CI) 0.81–0.96). Similarly, there was a significant reduction in the number of STEMI patients (RR 0.52, 95% CI 0.32–0.85), the incidence of OHCA remained unchanged (RR 1.23, 95% CI 0.83–1.83). Conclusion During the first COVID-19 lockdown, there was a significant reduction in the number of patients with chest pain or STEMI evaluated by the EMS, while the incidence of OHCA remained similar. Although the reason for the decrease in chest pain and STEMI consultations is not entirely clear, more attention should be paid to the importance of contacting the EMS in case of suspected cardiac symptoms in possible future lockdowns.

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Characterizing the influence of transportation infrastructure on Emergency Medical Services (EMS) in urban area—A case study of Seoul, South Korea

PLoS ONE ◽

10.1371/journal.pone.0183241 ◽

2017 ◽

Vol 12 (8) ◽

pp. e0183241 ◽

Cited By ~ 4

Author(s):

Jungwoo Cho ◽

Myoungsoon You ◽

Yoonjin Yoon

Keyword(s):

South Korea ◽

Emergency Medical Services ◽

Urban Area ◽

Transportation Infrastructure ◽

Medical Services ◽

Emergency Medical

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Temporal Trends in Emergency Medical Services and General Practitioner Use for Acute Stroke After Australian Public Education Campaigns

Stroke ◽

10.1161/strokeaha.118.023263 ◽

2018 ◽

Vol 49 (12) ◽

pp. 3078-3080 ◽

Cited By ~ 2

Author(s):

Janet E. Bray ◽

Judith Finn ◽

Peter Cameron ◽

Karen Smith ◽

Lahn Straney ◽

...

Keyword(s):

General Practitioner ◽

Public Education ◽

Acute Stroke ◽

Emergency Medical Services ◽

Temporal Trends ◽

Medical Services ◽

Emergency Medical ◽

Education Campaigns

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The Administration of Prehospital Ketamine for Chemical Restraint does not Prolong On-Scene Times Compared to Haloperidol Based Sedation

Australasian Journal of Paramedicine ◽

10.33151/ajp.12.1.8 ◽

2015 ◽

Vol 12 (1) ◽

Cited By ~ 2

Author(s):

Aaron Burnett ◽

Dolly Panchal ◽

Bjorn Peterson ◽

Eric Ernest ◽

Kent Griffith ◽

...

Keyword(s):

Emergency Medical Services ◽

Chart Review ◽

Retrospective Chart Review ◽

T Test ◽

Medical Services ◽

Demographic Differences ◽

Chemical Restraint ◽

Emergency Medical ◽

Clinically Significant ◽

The Impact

IntroductionAgitated patients who present a danger to themselves or emergency medical services (EMS) providers may require chemical restraints. Haloperidol is employed for chemical restraint in many EMS services. Recently, ketamine has been introduced as an alternate option for prehospital sedation. On-scene time is a unique metric in prehospital medicine which has been linked to outcomes in multiple patient populations. When used for chemical restraint, the impact of ketamine relative to haloperidol on on-scene time is unknown.Objective: To evaluate whether the use of ketamine for chemical restraint was associated with a clinically significant (≥5 minute) increased on-scene time compared to a haloperidol based regimen.MethodsPatients who received haloperidol or ketamine for chemical restraint were identified by retrospective chart review. On-scene time was compared between groups using an unadjusted Student t-test powered to 80% to detect a ≥5 minute difference in on-scene time.Results110 cases were abstracted (Haloperidol = 55; Ketamine = 55). Of the patients receiving haloperidol, 11/55 (20%) were co-administered a benzodiazepine, 4/55 (7%) received diphenhydramine and 34/55 (62%) received the three drugs in combination. There were no demographic differences between the haloperidol and ketamine groups. On-scene time was not statistically different for patients receiving a haloperidol based regimen compared to ketamine (18.2 minutes, [95% CI 15.7-20.8] vs. 17.6 minutes, [95% CI 15.1-20.0]; p = 0.71).ConclusionsThe use of prehospital ketamine for chemical restraint was not associated with a clinically significant (≥5 minute) increased on-scene time compared to a haloperidol based regimen.

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