scholarly journals Prehospital Triage of Acute Stroke Patients During the COVID-19 Pandemic

Stroke ◽  
2020 ◽  
Vol 51 (7) ◽  
pp. 2263-2267 ◽  
Author(s):  
Mayank Goyal ◽  
Johanna M. Ospel ◽  
Andrew M. Southerland ◽  
Charles Wira ◽  
Sepideh Amin-Hanjani ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Conceptual Framework ◽  
Emergency Medical Services ◽  
Stroke Patient ◽  
Medical Services ◽  
Acute Stroke Patient ◽  
Stroke Patients ◽  
Emergency Medical ◽  
The Future ◽  
Prehospital Triage

Abstract: The coronavirus disease 2019 (COVID-19) pandemic has broad implications on stroke patient triage. Emergency medical services providers have to ensure timely transfer of patients while minimizing the risk of infectious exposure for themselves, their co-workers, and other patients. This statement paper provides a conceptual framework for acute stroke patient triage and transfer during the COVID-19 pandemic and similar healthcare emergencies in the future.

scholarly journals Variability in Criteria for Emergency Medical Services Routing of Acute Stroke Patients to Designated Stroke Center Hospitals

2015 ◽  
Vol 16 (5) ◽  
pp. 743-746 ◽  
Author(s):  
Nikolay Dimitrov ◽  
William Koenig ◽  
Nichole Bosson ◽  
Sarah Song ◽  
Jeffrey Saver ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Emergency Medical Services ◽  
Medical Services ◽  
Stroke Patients ◽  
Emergency Medical ◽  
Stroke Center

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 ◽  
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.

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.

A National Assessment of Factors Influencing Emergency Medical Services Times among Acute Stroke Patients (P02.223)

Neurology ◽  
2012 ◽  
Vol 78 (Meeting Abstracts 1) ◽  
pp. P02.223-P02.223
Author(s):  
V. Jadhav ◽  
S. Pawar ◽  
S. Chaudhry ◽  
A. Hassan ◽  
G. Rodriguez ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Emergency Medical Services ◽  
Medical Services ◽  
Stroke Patients ◽  
National Assessment ◽  
Factors Influencing ◽  
Emergency Medical

Socioeconomic Influence on Emergency Medical Services Utilization for Acute Stroke: Think Nationally, Act Locally

2021 ◽  
pp. 194187442110100
Author(s):  
Matthew E. Ehrlich ◽  
Bin Han ◽  
Michael Lutz ◽  
Mohsen Ghiasi Ghorveh ◽  
Yasmin Ali Okeefe ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Emergency Medical Services ◽  
Social Factors ◽  
Medical Services ◽  
Stroke Patients ◽  
Services Utilization ◽  
Factors Associated ◽  
Emergency Medical ◽  
Medical Services Utilization ◽  
Future Education

Background and Purpose: Rates of emergency medical services (EMS) utilization for acute stroke remain low nationwide, despite the time-sensitive nature of the disease. Prior research suggests several demographic and social factors are associated with EMS use. We sought to evaluate which demographic or socioeconomic factors are associated with EMS utilization in our region, thereby informing future education efforts. Methods: We performed a retrospective analysis of patients for whom the stroke code system was activated at 2 hospitals in our region. Univariate and logistic regression analysis was performed to identify factors associated with use of EMS versus private vehicle. Results: EMS use was lower in patients who were younger, had higher income, were married, more educated and in those who identified as Hispanic. Those arriving by EMS had significantly faster arrival to code, arrival to imaging, and arrival to thrombolytic treatment times. Conclusion: Analysis of regional data can identify specific populations underutilizing EMS services for acute stroke symptoms. Factors effecting EMS utilization varies by region and this information may be useful for targeted education programs promoting EMS use for acute stroke symptoms. EMS use results in more rapid evaluation and treatment of stroke patients.

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

Stroke ◽  
2018 ◽  
Vol 49 (12) ◽  
pp. 3078-3080 ◽  
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

scholarly journals Accuracy of Emergency Medical Services–Reported Last Known Normal Times in Patients Suspected With Acute Stroke

Stroke ◽  
2014 ◽  
Vol 45 (5) ◽  
pp. 1275-1279 ◽  
Author(s):  
David Curfman ◽  
Lisa Tabor Connor ◽  
Hawnwan Philip Moy ◽  
Laura Heitsch ◽  
Peter Panagos ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Emergency Medical Services ◽  
Medical Services ◽  
Emergency Medical

scholarly journals Contacting out-of-hours primary care or emergency medical services for time-critical conditions - impact on patient outcomes

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Morten Breinholt Søvsø ◽  
Morten Bondo Christensen ◽  
Bodil Hammer Bech ◽  
Helle Collatz Christensen ◽  
Erika Frischknecht Christensen ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Healthcare Services ◽  
Medical Services ◽  
Critical Conditions ◽  
Stroke Patients ◽  
Out Of Hours ◽  
Icu Stay ◽  
Emergency Medical ◽  
Time Critical ◽  
Hospital Contact

Abstract Background Out-of-hours (OOH) healthcare services in Western countries are often differentiated into out-of-hours primary healthcare services (OOH-PC) and emergency medical services (EMS). Call waiting time, triage model and intended aims differ between these services. Consequently, the care pathway and outcome could vary based on the choice of entrance to the healthcare system. We aimed to investigate patient pathways and 1- and 1–30-day mortality, intensive care unit (ICU) stay and length of hospital stay for patients with acute myocardial infarction (AMI), stroke and sepsis in relation to the OOH service that was contacted prior to the hospital contact. Methods Population-based observational cohort study during 2016 including adult patients from two Danish regions with an OOH service contact on the date of hospital contact. Patients <18 years were excluded. Data was retrieved from OOH service databases and national registries, linked by a unique personal identification number. Crude and adjusted logistic regression analyses were performed to assess mortality in relation to contacted OOH service with OOH-PC as the reference and cox regression analysis to assess risk of ICU stay. Results We included 6826 patients. AMI and stroke patients more often contacted EMS (52.1 and 54.1%), whereas sepsis patients predominately called OOH-PC (66.9%). Less than 10% (all diagnoses) of patients contacted both OOH-PC & EMS. Stroke patients with EMS or OOH-PC & EMS contacts had higher likelihood of 1- and 1–30-day mortality, in particular 1-day (EMS: OR = 5.33, 95% CI: 2.82–10.08; OOH-PC & EMS: OR = 3.09, 95% CI: 1.06–9.01). Sepsis patients with EMS or OOH-PC & EMS contacts also had higher likelihood of 1-day mortality (EMS: OR = 2.22, 95% CI: 1.40–3.51; OOH-PC & EMS: OR = 2.86, 95% CI: 1.56–5.23) and 1–30-day mortality. Risk of ICU stay was only significantly higher for stroke patients contacting EMS (EMS: HR = 2.38, 95% CI: 1.51–3.75). Stroke and sepsis patients with EMS contact had longer hospital stays. Conclusions More patients contacted OOH-PC than EMS. Sepsis and stroke patients contacting EMS solely or OOH-PC & EMS had higher likelihood of 1- and 1–30-day mortality during the subsequent hospital contact. Our results suggest that patients contacting EMS are more severely ill, however OOH-PC is still often used for time-critical conditions.

scholarly journals Comparing the Air Medical Prehospital Triage Score With Current Practice for Triage of Injured Patients to Helicopter Emergency Medical Services

JAMA Surgery ◽  
2018 ◽  
Vol 153 (3) ◽  
pp. 261 ◽  
Author(s):  
Joshua B. Brown ◽  
Kenneth J. Smith ◽  
Mark L. Gestring ◽  
Matthew R. Rosengart ◽  
Timothy R. Billiar ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Current Practice ◽  
Medical Services ◽  
Helicopter Emergency Medical Services ◽  
Emergency Medical ◽  
Prehospital Triage ◽  
Injured Patients
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