Abstract WP292: Temporal Trends in the Use of Ems Service as a Mode of Arrival by Acute Ischemic Stroke Patients

Intro: Utilization of emergency medical services (EMS) can increase the likelihood of appropriate therapy with IV tPA or endovascular intervention. We investigate the use of EMS services in three large states across the US during the past decade. Methods: Using GWTG stroke registry data from three large comprehensive stroke centers in the Northeast, South and West, we analyzed 9,251 stroke admissions from 01/2010 - 12/2018. Overall rates of EMS use and temporal trends were computed. Factors associated with EMS use were evaluated with univariate analysis. Results: Of the 9,251 patients, 29.2 % (2,697/9,251) presented via EMS service. Overtime use of EMS service increased from 29% in 2010-11 to 34% in 2018. Use of EMS increased among severe stroke patients but decreased among mild stroke patients. Patients presenting via EMS were older, more often females while less often African Americans. They had more stroke risk factors, including hypertension, diabetes, atrial fibrillation and previous stroke/TIA. Smokers less often use EMS services. Median NIHSS was higher among patients presenting via EMS, and those with altered level of consciousness used EMS more often. In-hospital intervention rates (IV tPA/endovascular) were higher among patients presenting via EMS. Conclusion: Our results showed that after extensive EMS education in most parts of the study states, stroke presentation has increased via EMS overtime. Disparity in the use of EMS still exists with African Americans using the service less often. Patients should be encouraged to use EMS services and decrease delay in presentation which can results in higher rates of intervention.

Abstract TP260: Reducing Time From Pre-Hospital to Arterial Puncture in Acute Ischemic Stroke

Background and Purpose: Efficacy of mechanical thrombectomy for acute cerebral large vessel occlusion depends on time from symptom onset to reperfusion. While time to treatment in hospital has been optimized in these days, it is not well-known about improving time in pre-hospital when suspected stroke. We sought to analyze time from emergency medical services (EMS) dispatch to arterial puncture in stroke patients eligible for mechanical thrombectomy. Methods: We analyzed time components from EMS dispatch to puncture in patients with acute large vessel occlusion within 6 hours from onset treated with mechanical thrombectomy between April 2015 and December 2018. We assessed the associated factors with each time component and patient outcomes. Results: Consecutive 195 patients were included in this analysis. The median EMS dispatch-to-scene, on-scene, transport, door-to-puncture (DTP), and scene-to-puncture (STP) times were 4, 16, 12, 40, and 70 minutes, respectively. Percentage of favorable outcomes were significantly higher in patients with STP within 60 minutes (57.5% vs 35.8%, p<0.05). Direct call from EMS, lower number of acceptance request times, shorter transport distance, and out-of-home onset were significantly associated with STP within 60 minutes (P<0.01). EMS education program shortened STP times and increased use of direct call which significantly reduced on-scene (15.9 vs 20.2), DTP (40.4 vs 57.8), and STP (68.9 vs 91.5) times (P<0.001). Conclusions: Reducing time in pre-hospital and in-hospital interact with each other. Education program and use of direct call from EMS contributed to reducing these times.

Emergency medical services core competencies: a Delphi study

IntroductionThe emergency medical services (EMS) education in Saudi Arabia has evolved considerably during the past decade and this rapid improvement has seen a disparity of educational approaches. Therefore, a core competency framework which aligns with the requirements of Saudi EMS education should be identified and accommodated. The aim of this study was to obtain professional group consensus on the desirable core competencies for EMS Bachelor degree graduates in Saudi Arabia in order to develop a core competency framework for Saudi Arabian EMS.MethodsA two-round Delphi method using a quantitative survey with a purposeful sampling technique of expert information-rich participants was used. The instrument comprised 40 core competency statements (rated on a 1-10 Likert scale, with 1 being ‘not important at all’ and 10 being ‘extremely important’) and an open-ended question. An international systematic scoping review and local national review informed the items in this study.ResultsAt the end of the second round, the response rate was 70%, and the sample demonstrated diversity in terms of qualifications, expertise and discipline. All core competencies achieved a majority and stability in the first and second rounds. Core competency items achieved the 75% consensus requirement.ConclusionThis study provided consensus on 41 core competencies specific to Saudi EMS industry requirements. However, the findings do not represent a definitive blueprint model for alignment into EMS curricula. Further research and statistical modelling for the core competencies are highly recommended.

Influence of Family on Saudi Arabian Emergency Medical Services Students

<p>Objective: To identify influences on learning for Saudi male students studying Emergency Medical Services at a college in Riyadh, Saudi Arabia. Previous research on influences on student learning in the Kingdom of Saudi Arabia focused on the historical development of education in Saudi Arabia, English language development, and intrinsic motivations of students and excluded a focus on students studying Emergency Medical Services. Methods: Exploratory sequential mixed-methods study was deployed. Results: Family support was an exceptionally strong predictor of student confidence in both skills and post-graduate EMS employment. Concepts involving application, memorization, motivation, and English language did not present as statically significant. The discovery of the strong influences that a family can have on Saudi EMS student’s confidence is noteworthy, as this was not previously discovered in the literature. Conclusion: This discovery holds practical implications for EMS education and training programs as emphasizes the importance of developing practical ways to include a student’s family as a source of support in ensuring student success and confidence. <strong></strong></p>