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Stroke ems transport

Prasanna Venkatesan Eswaradass, Richard H Swartz, Jamey Rosen, Michael D Hill, M Patrice Lindsay
BACKGROUND: Canada's vast geography creates challenges for ensuring prompt transport to hospital of patients who have had a stroke. We sought to determine the proportion of people across various Canadian provinces for whom hyperacute stroke services are accessible within evidence-based time targets. METHODS: We calculated, for the 8 provinces with available data, drive-time polygons on a map of Canada that delineated the area around stroke centres and emergency medical services (EMS) base centres to which one can drive in 3...
June 14, 2017: CMAJ Open
Richard H Swartz, Elizabeth Linkewich, Shelley Sharp, Jacqueline Willems, Chris Olynyk, Nicola Tahair, Megan L Cayley, Mark T Bayley
BACKGROUND: Hyperacute stroke is a time-sensitive emergency for which outcomes improve with faster treatment. When stroke systems are accessed via emergency medical services (EMS), patients are routed to hyperacute stroke centres and are treated faster. But over a third of patients with strokes do not come to the hospital by EMS, and may inadvertently arrive at centres that do not provide acute stroke services. We developed and studied the impact of protocols to quickly identify and move "walk-in" patients from non-hyperacute hospitals to regional stroke centres (RSCs)...
May 9, 2017: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
Mellanie V Springer, Daniel L Labovitz, Ethan C Hochheiser
OBJECTIVE: Conflicting reports exist about hospital arrival time after stroke onset in Hispanics compared with African Americans and Caucasians. Our current study investigates race-ethnic disparities in hospital arrival times after stroke onset. METHODS: We performed a retrospective analysis of hospital arrival times in Hispanic, African American, and Caucasian acute ischemic stroke patients (N=1790) presenting to a tertiary-care hospital in the Bronx, New York...
2017: Ethnicity & Disease
Ian Medoro, David C Cone
BACKGROUND AND PURPOSE: Studies have shown a reduction in time-to-CT and improved process measures when EMS personnel notify the ED of a "stroke alert" from the field. However, there are few data on the accuracy of these EMS stroke alerts. The goal of this study was to examine diagnostic test performance of EMS and ED stroke alerts and related process measures. METHODS: The EMS and ED records of all stroke alerts in a large tertiary ED from August 2013-January 2014 were examined and data abstracted by one trained investigator, with data accuracy confirmed by a second investigator for 15% of cases...
July 2017: Prehospital Emergency Care
A Olascoaga Arrate, M M Freijo Guerrero, C Fernández Maiztegi, I Azkune Calle, R Silvariño Fernández, M Fernández Rodríguez, P Vazquez Naveira, A Anievas Elena, I Iturraspe González, Y Pérez Díez, R Ruiz Fernández
INTRODUCTION: According to numerous studies, using emergency medical services (EMS) to transport stroke patients to hospitals decreases diagnostic and treatment delays. OBJECTIVES: To determine the frequency of use of EMS by stroke patients in Bizkaia (Spain), analyse the factors associated with using EMS, and study the impact of EMS on time to care. METHODS: We gathered data from 545 patients hospitalised for acute ischaemic stroke and recruited consecutively...
January 13, 2017: Neurología: Publicación Oficial de la Sociedad Española de Neurología
Andrew Hawk, Catherine Marco, Matt Huang, Bonnie Chow
OBJECTIVE: The purpose of this study was to examine the usefulness of an emergency medical service (EMS)-requested air medical helicopter response directly to the scene for a patient with clinical evidence of an ischemic cerebrovascular accident (CVA) and transport to a regional comprehensive CVA center. METHODS: CareFlight, an air medical critical care transportation service, is based in Dayton, OH. The 3 CareFlight helicopters are geographically located and provided transport to all CVA scene patients in this study...
November 2016: Air Medical Journal
C Mouthon-Reignier, I Bonnaud, M Gaudron, S Vannier-Bernard, J-F Bodin, J-P Cottier, B De Toffol, S Debiais
INTRODUCTION: This study examined the impact of a "direct potential thrombolysis" pathway with direct admission to a neurological stroke unit (SU) on delays of admission, stroke care and proportion of patients with ischemic stroke (IS) treated with intravenous (IV) rtPA. METHODS: This prospective study included all patients admitted in the intensive SU for potential thrombolysis over a 2-month period. Data collected included the time of symptom onset, mode of transport, National Institutes of Health Stroke Scale (NIHSS) score on arrival, delays of care, delays of imaging and modalities, diagnosis and therapeutic data...
December 2016: Revue Neurologique
Thomas V Kodankandath, Paul Wright, Paul M Power, Marcella De Geronimo, Richard B Libman, Thomas Kwiatkowski, Jeffrey M Katz
BACKGROUND AND OBJECTIVE: The transfer of acute ischemic stroke (AIS) patients to a comprehensive stroke center (CSC) must be rapid. Delays pose an obstacle to time-sensitive stroke treatments and, therefore, increase the likelihood of exclusion from endovascular stroke therapy. This study aims to evaluate the impact of the Stroke Rescue Program, with its goal of minimizing interfacility transfer delays and increasing the number of transport times completed within 60 minutes. METHODS: The Stroke Rescue Program was initiated to facilitate the rapid transfer of AIS patients from regional primary stroke centers (PSCs) to the network's CSC...
January 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Aliza T Brown, Feifei Wei, William C Culp, Greg Brown, Ryan Tyler, Appathurai Balamurugan, Nicolas Bianchi
INTRODUCTION: Time delay is the key obstacle for receiving successful stroke treatment. Alteplase therapy must start within 4.5 hours from stroke occurrence. Rapid transport to a primary stroke center (PSC) or acute stroke-ready hospital (ASRH) by the emergency medical system (EMS) paramedics is vital. We determined transport time and destination data for EMS-identified and -delivered stroke suspects in Arkansas during 2013. Our objective was to analyze transport time and the hospital qualification for stroke care across the state...
August 2016: American Journal of Emergency Medicine
Michael E Abboud, Roger Band, Judy Jia, William Pajerowski, Guy David, Michelle Guo, C Crawford Mechem, Steven R Messé, Brendan G Carr, Michael T Mullen
OBJECTIVE: Hospital arrival via Emergency Medical Services (EMS) and EMS prenotification are associated with faster evaluation and treatment of stroke. We sought to determine the impact of diagnostic accuracy by prehospital providers on emergency department quality measures. METHODS: A retrospective study was performed of patients presenting via EMS between September 2009 and December 2012 with a discharge diagnosis of transient ischemic attack (TIA), ischemic stroke (IS), or intracerebral hemorrhage (ICH)...
November 2016: Prehospital Emergency Care
Brit J Long, Luis A Serrano, Jose G Cabanas, M Fernanda Bellolio
UNLABELLED: Introduction Emergency Medical Service (EMS) systems are vital in the identification, assessment, and treatment of trauma, stroke, myocardial infarction, and sepsis patients, improving early recognition, resuscitation, and transport. Emergency Medical Service personnel provide similar care for patients with syncope. The role of EMS in the management of patients with syncope has not been reported. Hypothesis/Objective The objective of this study was to describe the management of out-of-hospital syncope by prehospital providers in an urban EMS system...
August 2016: Prehospital and Disaster Medicine
Laura C Gioia, Rahel T Zewude, Mahesh P Kate, Kim Liss, Brian H Rowe, Brian Buck, Thomas Jeerakathil, Ken Butcher
OBJECTIVE: To assess the natural history of prehospital blood pressure (BP) during emergency medical services (EMS) transport of suspected stroke and determine whether prehospital BP differs among types of patients with suspected stroke (ischemic stroke, TIA, intracerebral hemorrhage [ICH], or stroke mimic). METHODS: A retrospective, cross-sectional, observational analysis of a centralized EMS database containing electronic records of patients transported by EMS to the emergency department (ED) with suspected stroke during an 18-month period was conducted...
June 7, 2016: Neurology
Simone Vidale, Marco Arnaboldi, Giacomo Bezzi, Giorgio Bono, Giampiero Grampa, Mario Guidotti, Patrizia Perrone, Andrea Salmaggi, Davide Zarcone, Alberto Zoli, Elio Agostoni
BACKGROUND AND PURPOSE: Thrombolysis represents the best therapy for ischemic stroke but the main limitation of its administration is time. The avoidable delay is a concept reflecting the effectiveness of management pathway. For this reason, we projected a study concerning the detection of main delays with following introduction of corrective factors. In this paper we describe the results after these corrections. MATERIALS AND METHODS: Consecutive patients admitted for ischemic stroke during a 3-months period to 35 hospitals of a macro-area of Northern Italy were enrolled...
July 15, 2016: International Journal of Cardiology
Dae-Hyun Kim, Hyun-Wook Nah, Hyun-Seok Park, Jae-Hyung Choi, Myong-Jin Kang, Jae-Taeck Huh, Jae-Kwan Cha
BACKGROUND: The use of emergency medical services (EMS) and notification to hospitals by paramedics for patients with suspected stroke are crucial determinants in reducing delay time to acute stroke treatment. The aim of this study is to investigate whether EMS use and prehospital notification (PN) can shorten the time to thrombolytic therapy in a stroke center with a systemized stroke code program. METHODS: Beginning in January 2012, stroke experts in our stroke center received direct calls via mobile phone from paramedics prenotifying the transport of patients with suspected stroke...
July 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Tuukka Puolakka, Taneli Väyrynen, Elja-Pekka Erkkilä, Markku Kuisma
UNLABELLED: Introduction On-scene time (OST) previously has been shown to be a significant component of Emergency Medical Services' (EMS') operational delay in acute stroke. Since stroke patients are managed routinely by two-person ambulance crews, increasing the number of personnel available on the scene is a possible method to improve their performance. Hypothesis Using fire engine crews to support ambulances on the scene in acute stroke is hypothesized to be associated with a shorter OST...
June 2016: Prehospital and Disaster Medicine
Nancy K Glober, Karl A Sporer, Kama Z Guluma, John P Serra, Joe A Barger, John F Brown, Gregory H Gilbert, Kristi L Koenig, Eric M Rudnick, Angelo A Salvucci
INTRODUCTION: In the United States, emergency medical services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with a suspected stroke and to compare these recommendations against the current protocols used by the 33 EMS agencies in the state of California. METHODS: We performed a literature review of the current evidence in the prehospital treatment of a patient with a suspected stroke and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations...
March 2016: Western Journal of Emergency Medicine
Jennifer Schwartz, Rachel P Dreyer, Karthik Murugiah, Isuru Ranasinghe
BACKGROUND AND PURPOSE: There are no contemporary national-level data on Emergency Medical Services (EMS) response times for suspected stroke in the United States (US). Because effective stroke treatment is time-dependent, we characterized response times for suspected stroke, and examined whether they met guideline recommendations. METHODS: Using the National EMS Information System dataset, we included 911 calls for patients ≥ 18 years with an EMS provider impression of stroke...
September 2016: Prehospital Emergency Care
Evan Hodell, Shana D Hughes, Megan Corry, Sean Kivlehan, Brian Resler, Nicolas Sheon, Prasanthi Govindarajan
BACKGROUND: Emergency Medical Service (EMS) providers are tasked with rapid evaluation, stabilization, recognition, and transport of acute stroke patients. Although prehospital stroke scales were developed to assist with stroke recognition, unrecognized challenges exist in the prehospital setting that hinder accurate assessment of stroke. The goal of this qualitative study was to systematically understand the challenges and barriers faced by paramedics in recognizing stroke presentations in the field...
May 2016: Prehospital Emergency Care
Mark Faul, Judy A Stevens, Scott M Sasser, Lisa Alee, Angela J Deokar, Deborah A Kuhls, Peter A Burke
INTRODUCTION: Among people aged ≥65 years, falling is the leading cause of emergency department visits. Emergency medical services (EMS) are often called to help older adults who have fallen, with some requiring hospital transport. Chief aims were to determine where falls occurred and the circumstances under which patients were transported by EMS, and to identify future fall prevention opportunities. METHODS: In 2012, a total of 42 states contributed ambulatory data to the National EMS Information System, which were analyzed in 2014 and 2015...
June 2016: American Journal of Preventive Medicine
Sola Kim, Sang Do Shin, Young Sun Ro, Kyoung Jun Song, Yu Jin Lee, Eui Jung Lee, Ki Ok Ahn, Taeyun Kim, Ki Jeong Hong, Yu Jin Kim
BACKGROUND: It is unclear whether the use of emergency medical services (EMS) is associated with enhanced survival and decreased disability after hemorrhagic stroke and whether the effect size of EMS use differs according to the length of stay (LOS) in emergency department (ED). METHODS: Adult patients (19 years and older) with acute hemorrhagic stroke who survived to admission at 29 hospitals between 2008 and 2011 were analyzed, excluding those who had symptom-to-ED arrival time of 3 h or greater, received thrombolysis or craniotomy before inter-hospital transfer, or had experienced cardiac arrest, had unknown information about ambulance use and outcomes...
May 2016: Prehospital Emergency Care
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