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Stroke ems prehospital routing

C H Nolte, H J Audebert
The effectiveness of thrombolysis or mechanical recanalization for acute stroke is higher, the sooner these therapies are started. Therefore, acute stroke patients need to be evaluated by qualified staff for these therapies as soon as possible. Lay persons need to identify the typical symptoms of stroke as an emergency and act accordingly by calling the emergency medical system (EMS). The EMS team reassesses the symptoms and prompts cerebral imaging. Cerebral imaging is performed ideally in hospitals with a stroke unit where subsequent (stroke) treatments occur...
November 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
Kevin M Barrett, Michael A Pizzi, Vivek Kesari, Sarvam P TerKonda, Elizabeth A Mauricio, Scott M Silvers, Ranya Habash, Benjamin L Brown, Rabih G Tawk, James F Meschia, Robert Wharen, William D Freeman
BACKGROUND: Ischemic stroke is a time-sensitive disease, with improved outcomes associated with decreased time from onset to treatment. It was hypothesised that ambulance-based assessment of the National Institutes of Health Stroke Scale (NIHSS) using a Health Insurance Portability and Accountability Act (HIPAA)-compliant mobile platform immediately prior to arrival is feasible. METHODS: This is a proof-of-concept feasibility pilot study in two phases. The first phase consisted of an ambulance-equipped HIPAA-compliant video platform for remote NIHSS assessment of a simulated stroke patient...
May 13, 2016: Journal of Telemedicine and Telecare
Jason M Lippman, Sherita N Chapman Smith, Timothy L McMurry, Zachary G Sutton, Brian S Gunnell, Jack Cote, Debra G Perina, David C Cattell-Gordon, Karen S Rheuban, Nina J Solenski, Bradford B Worrall, Andrew M Southerland
BACKGROUND: The use of telemedicine in the diagnosis and treatment of acute stroke, or telestroke, is a well-accepted method of practice improving geographic disparities in timely access to neurological expertise. We propose that mobile telestroke assessment during ambulance transport is feasible using low-cost, widely available technology. MATERIALS AND METHODS: We designed a platform including a tablet-based end point, high-speed modem with commercial wireless access, external antennae, and portable mounting apparatus...
June 2016: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
Nikolay Dimitrov, William Koenig, Nichole Bosson, Sarah Song, Jeffrey L Saver, William J Mack, Nerses Sanossian
INTRODUCTION: Comprehensive stroke systems of care include routing to the nearest designated stroke center hospital, bypassing non-designated hospitals. Routing protocols are implemented at the state or county level and vary in qualification criteria and determination of destination hospital. We surveyed all counties in the state of California for presence and characteristics of their prehospital stroke routing protocols. METHODS: Each county's local emergency medical services agency (LEMSA) was queried for the presence of a stroke routing protocol...
September 2015: Western Journal of Emergency Medicine
Matthew L Clark, Toby Gropen
The stroke system of care is undergoing significant evolution. There are promising data to suggest that with new technologies and approaches, primary prevention and community education will become easier and more accessible, and will allow people to have greater participation in their own healthcare. The evidence-based primary and comprehensive stroke center concepts have been translated into robust, rapidly growing certification programs. The continued dissemination of improved EMS routing protocols allows for better allocation of patients to stroke centers, even as we confront the challenge of further improving prehospital recognition of stroke...
January 2015: Current Treatment Options in Cardiovascular Medicine
Andrew W Asimos, Shana Ward, Jane H Brice, Wayne D Rosamond, Larry B Goldstein, Jonathan Studnek
STUDY OBJECTIVE: Emergency medical services (EMS) protocols, which route patients with suspected stroke to stroke centers, rely on the use of accurate stroke screening criteria. Our goal is to conduct a statewide EMS agency evaluation of the accuracies of the Cincinnati Prehospital Stroke Scale (CPSS) and the Los Angeles Prehospital Stroke Screen (LAPSS) for identifying acute stroke patients. METHODS: We conducted a retrospective study in North Carolina by linking a statewide EMS database to a hospital database, using validated deterministic matching...
November 2014: Annals of Emergency Medicine
Edward Durant, Karl A Sporer
OBJECTIVE: This cross-sectional study describes the characteristics of patients with an abnormal Glasgow Coma Scale (GCS) in the prehospital setting. METHODS: We reviewed existing prehospital care reports (PCRs) in the San Mateo County, California, emergency medical services (EMS) database from January 1 to December 31, 2007. Adults age 18 or greater with a documented GCS fit inclusion criteria. We excluded single and multisystem trauma patients, as well as patients in cardiac arrest, respiratory arrest, or listed as deceased from the study...
February 2011: Western Journal of Emergency Medicine
Brett S Whyte, Randall Ansley
OBJECTIVE: To evaluate the effect of a system of financial reward for emergency medical technicians (EMTs) who meet selected quality marker goals. METHODS: This project was reviewed by an institutional review board (IRB) and was found to be exempt from IRB review. Two operational and four clinical markers were targeted for improvement. Baseline performance measurements were retrospectively measured for the preceding year, and challenging but achievable goals for improvement were established...
October 2008: Prehospital Emergency Care
Todd Crocco, Travis Gullett, Stephen M Davis, Nicole Flores, Laura Sauerbeck, Edward Jauch, Billie Threlkeld, Brian Pio, Michael Ottaway, Arthur Pancioli, Thomas Chenier
BACKGROUND AND PURPOSE: Studies have demonstrated the importance of early stroke treatment. If a neuroprotective agent (NA) clinical trial is successful, the greatest benefit might be attained with early prehospital administration. This study determined the potential reduction in time to treatment of stroke patients when NAs were administered in the prehospital setting. METHODS: Twenty-three urban emergency medical services (EMS) agencies participated in this study...
August 2003: Stroke; a Journal of Cerebral Circulation
P E Pepe, B S Zachariah, M R Sayre, D Floccare
Until recently, the prehospital and emergency department management of nonhemorrhagic stroke was largely supportive care. Studies now have demonstrated the potential of certain therapeutic interventions to reverse the debilitating consequences of such strokes. But despite the potential benefit, there exists a clear time dependency for such interventions, not only to ensure therapeutic efficacy, but also to diminish the likelihood of significant therapeutic complications. In turn, to optimize the chances of a better outcome for the patient with stroke, each community must establish and continue to refine a chain of recovery for stroke patients...
April 1998: Prehospital Emergency Care
P E Pepe, B S Zachariah, M R Sayre, D Floccare
Until recently, the prehospital and ED management of nonhemorrhagic stroke was largely supportive care. Studies have now demonstrated the potential of certain therapeutic interventions to reverse the debilitating consequences of such strokes. The clinical benefit for such interventions and the risk of significant therapeutic complications are highly time-dependent. To optimize the chances of a better outcome for the patient with stroke, each community must establish and continue to refine a chain of recovery for stroke patients...
April 1998: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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