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Stroke, prehospital, emergency medical services, paramedics

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https://www.readbyqxmd.com/read/27067887/impact-of-prehospital-intervention-on-delay-time-to-thrombolytic-therapy-in-a-stroke-center-with-a-systemized-stroke-code-program
#1
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
https://www.readbyqxmd.com/read/26855299/paramedic-perspectives-on-barriers-to-prehospital-acute-stroke-recognition
#2
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
https://www.readbyqxmd.com/read/26265130/routing-ambulances-to-designated-centers-increases-access-to-stroke-center-care-and-enrollment-in-prehospital-research
#3
Nerses Sanossian, David S Liebeskind, Marc Eckstein, Sidney Starkman, Samuel Stratton, Franklin D Pratt, William Koenig, Scott Hamilton, May Kim-Tenser, Robin Conwit, Jeffrey L Saver
BACKGROUND AND PURPOSE: Emergency medical services routing of patients with acute stroke to designated centers may increase the proportion of patients receiving care at facilities meeting national standards and augment recruitment for prehospital stroke research. METHODS: We analyzed consecutive patients enrolled within 2 hours of symptom onset in a prehospital stroke trial, before and after regional Los Angeles County Emergency Medical Services implementation of preferentially routing patients with acute stroke to approved stroke centers (ASCs)...
October 2015: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/25116305/prehospital-stroke-care-limitations-of-current-interventions-and-focus-on-new-developments
#4
REVIEW
Laetitia Yperzeele, Robbert-Jan Van Hooff, Ann De Smedt, Alexis Valenzuela Espinoza, Rohny Van de Casseye, Ives Hubloue, Jacques De Keyser, Raf Brouns
BACKGROUND: The global burden of stroke is immense, both in medical and economic terms. With the aging population and the ongoing industrialization of the third world, stroke prevalence is expected to increase and will have a major effect on national health expenditures. Currently, the medical treatment for acute ischemic stroke is limited to intravenous recombinant tissue plasminogen activator (IV r-tPA), but its time dependency leads to low utilization rates in routine clinical practice...
2014: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/24746847/out-of-hospital-stroke-screen-accuracy-in-a-state-with-an-emergency-medical-services-protocol-for-routing-patients-to-acute-stroke-centers
#5
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
https://www.readbyqxmd.com/read/24078198/paramedic-initiated-lisinopril-for-acute-stroke-treatment-pil-fast-results-from-the-pilot-randomised-controlled-trial
#6
RANDOMIZED CONTROLLED TRIAL
Lisa Shaw, Christopher Price, Sally McLure, Denise Howel, Elaine McColl, Paul Younger, Gary A Ford
BACKGROUND: High blood pressure (BP) during acute stroke is associated with poorer stroke outcome. Trials of treatments to lower BP have not resulted in improved outcome, but this may be because treatment commenced too late. Emergency medical service staff (paramedics) are uniquely placed to administer early treatment; however, experience of prehospital randomised controlled trials (RCTs) is very limited. METHODS: We conducted a pilot RCT to determine the feasibility of a definitive prehospital BP-lowering RCT in acute stroke...
December 2014: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/23897876/prehospital-stroke-care-new-prospects-for-treatment-and-clinical-research
#7
REVIEW
Heinrich J Audebert, Jeffrey L Saver, Sidney Starkman, Kennedy R Lees, Matthias Endres
Brain cells die rapidly after stroke and any effective treatment must start as early as possible. In clinical routine, the tight time-outcome relationship continues to be the major limitation of therapeutic approaches: thrombolysis rates remain low across many countries, with most patients being treated at the late end of the therapeutic window. In addition, there is no neuroprotective therapy available, but some maintain that this concept may be valid if administered very early after stroke. Recent innovations have opened new perspectives for stroke diagnosis and treatment before the patient arrives at the hospital...
July 30, 2013: Neurology
https://www.readbyqxmd.com/read/23689873/prenotification-and-other-factors-involved-in-rapid-tpa-administration
#8
Jamsheed A Desai, Eric E Smith
In acute ischemic stroke, time is brain. Current guidelines recommend that the time from arrival at hospital to initiation of administration of tissue plasminogen activator, also known as the door-to-needle (DTN) time, should be 60 min or less. However, DTN times in practice usually exceed this recommended time. The median DTN times from the American Heart Association/American Stroke Association Get With The Guidelines-Stroke program and the multinational Safe Implementation of Treatment in Stroke International Stroke Thrombolysis Register are 75 min and 65 min, respectively...
July 2013: Current Atherosclerosis Reports
https://www.readbyqxmd.com/read/23495755/assessing-the-validity-of-the-cincinnati-prehospital-stroke-scale-and-the-medic-prehospital-assessment-for-code-stroke-in-an-urban-emergency-medical-services-agency
#9
MULTICENTER STUDY
Jonathan R Studnek, Andrew Asimos, Jodi Dodds, Doug Swanson
OBJECTIVES: The primary objective of this study was to assess the effectiveness of two prehospital stroke screens in correctly classifying patients suspected of having a stroke. Secondarily, differences in the sensitivity and specificity of the two screening tools were assessed. METHODS: We performed a retrospective assessment of the Cincinnati Prehospital Stroke Scale (CPSS) and the Medic Prehospital Assessment for Code Stroke (Med PACS) between March 1, 2011, and September 30, 2011, in a single emergency medical services (EMS) agency with seven local hospitals all classified as stroke-capable...
July 2013: Prehospital Emergency Care
https://www.readbyqxmd.com/read/23223534/prehospital-thrombolysis-in-acute-stroke-results-of-the-phantom-s-pilot-study
#10
Joachim E Weber, Martin Ebinger, Michal Rozanski, Carolin Waldschmidt, Matthias Wendt, Benjamin Winter, Philipp Kellner, André Baumann, Jochen B Fiebach, Kersten Villringer, Sabina Kaczmarek, Matthias Endres, Heinrich J Audebert
OBJECTIVE: Beneficial effects of IV tissue plasminogen activator (tPA) in acute ischemic stroke are strongly time-dependent. In the Pre-Hospital Acute Neurological Treatment and Optimization of Medical care in Stroke (PHANTOM-S) study, we undertook stroke treatment using a specialized ambulance, the stroke emergency mobile unit (STEMO), to shorten call-to-treatment time. METHODS: The ambulance was staffed with a neurologist, paramedic, and radiographer and equipped with a CT scanner, point-of-care laboratory, and a teleradiology system...
January 8, 2013: Neurology
https://www.readbyqxmd.com/read/22335736/intramuscular-versus-intravenous-therapy-for-prehospital-status-epilepticus
#11
RANDOMIZED CONTROLLED TRIAL
Robert Silbergleit, Valerie Durkalski, Daniel Lowenstein, Robin Conwit, Arthur Pancioli, Yuko Palesch, William Barsan
BACKGROUND: Early termination of prolonged seizures with intravenous administration of benzodiazepines improves outcomes. For faster and more reliable administration, paramedics increasingly use an intramuscular route. METHODS: This double-blind, randomized, noninferiority trial compared the efficacy of intramuscular midazolam with that of intravenous lorazepam for children and adults in status epilepticus treated by paramedics. Subjects whose convulsions had persisted for more than 5 minutes and who were still convulsing after paramedics arrived were given the study medication by either intramuscular autoinjector or intravenous infusion...
February 16, 2012: New England Journal of Medicine
https://www.readbyqxmd.com/read/22261817/transcranial-ultrasound-from-diagnosis-to-early-stroke-treatment-part-2-prehospital-neurosonography-in-patients-with-acute-stroke-the-regensburg-stroke-mobile-project
#12
Felix Schlachetzki, Moriz Herzberg, Thilo Hölscher, Michael Ertl, Markus Zimmermann, Karl Peter Ittner, Hendrik Pels, Ulrich Bogdahn, Sandra Boy
BACKGROUND AND PURPOSE: The primary aim of this study was to investigate the diagnostic accuracy and time frames for neurological and transcranial color-coded sonography (TCCS) assessments in a prehospital '911' emergency stroke situation by using portable duplex ultrasound devices to visualize the bilateral middle cerebral arteries (MCAs). METHODS: This study was conducted between May 2010 and January 2011. Patients who had sustained strokes in the city of Regensburg and the surrounding area in Bavaria, Germany, were enrolled in the study...
2012: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/21966316/standardized-prehospital-treatment-of-stroke
#13
REVIEW
Christof Kessler, Alexander V Khaw, Darius G Nabavi, Jörg Glahn, Martin Grond, Otto Busse
BACKGROUND: The lack of standardized pre-hospital treatment is a weak link in the care of acute stroke patients. METHODS: Selective review of the literature on acute stroke, with consideration of current guidelines in Germany and other countries (DGN, ESO, AHA/ASA). RESULTS: The mandatory, immediate transfer of acute stroke patients to a specialized stroke unit is supported by high-level evidence. Simple, sensitive screening tests for the diagnosis of stroke are available that can be performed in the field by trained non-physician emergency medical personnel...
September 2011: Deutsches Ärzteblatt International
https://www.readbyqxmd.com/read/21691469/characteristics-of-patients-with-an-abnormal-glasgow-coma-scale-score-in-the-prehospital-setting
#14
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
https://www.readbyqxmd.com/read/21050409/the-rural-prehospital-acute-stroke-triage-past-trial-protocol-a-controlled-trial-for-rapid-facilitated-transport-of-rural-acute-stroke-patients-to-a-regional-stroke-centre
#15
Ashley R Garnett, Dianne L Marsden, Mark W Parsons, Debbie A Quain, Neil J Spratt, Allan R Loudfoot, Paul M Middleton, Christopher R Levi
RATIONALE: Access to intravenous thrombolysis for acute ischaemic stroke is limited worldwide, particularly in regional and rural areas including in Australia. We are testing the effectiveness of a new rural Prehospital Acute Stroke Triage protocol that includes prehospital assessment and rapid transport of patients from a rural catchment to the major stroke centre in Newcastle, NSW, Australia. The local district hospitals within the rural catchment do not have the capability or infrastructure to deliver acute stroke thrombolysis...
December 2010: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/20980754/utility-of-the-kurashiki-prehospital-stroke-scale-for-hyperacute-stroke
#16
COMPARATIVE STUDY
Yasuyuki Iguchi, Kazumi Kimura, Masao Watanabe, Kensaku Shibazaki, Junya Aoki
BACKGROUNDS: Our aim was to confirm the utility of paramedics using the Kurashiki Prehospital Stroke Scale (KPSS), with a maximum score of 13, for patients who may be eligible for administration of intravenous tissue plasminogen activator (IV t-PA). METHODS: The subjects comprised acute stroke and transient ischemic attack (TIA) patients transferred to our hospital by paramedics. We analyzed correlations between KPSS and the National Institutes of Health Stroke Scale (NIHSS)...
2011: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/20538702/paramedic-diagnosis-of-stroke-examining-long-term-use-of-the-melbourne-ambulance-stroke-screen-mass-in-the-field
#17
COMPARATIVE STUDY
Janet E Bray, Kelly Coughlan, Bill Barger, Chris Bladin
BACKGROUND AND PURPOSE: Recent evidence suggests the Cincinnati Prehospital Stroke Scale is ineffectively used and lacks sensitivity and specificity. Melbourne (Australia) paramedics have been using the Melbourne Ambulance Stroke Screen (MASS) since 2005. The aim of this study was to review the real-world use of MASS 3 years after city wide implementation. METHODS: Two groups of consecutively admitted patients to an Australian hospital between January and May 2008 were used: (1) patients for whom paramedics performed MASS; and (2) patients with a discharge diagnosis of stroke or transient ischemic attack...
July 2010: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/20498186/set-up-and-run-a-thrombolysis-service-for-acute-stroke
#18
REVIEW
Keith W Muir, Tracey Baird
Intravenous thrombolysis significantly improves the chance of independent recovery from ischaemic stroke but its benefit is strongly time dependent: present evidence supports effectiveness when delivered up to 4.5 h after symptom onset but the chance of recovery is twice as great when it is given within 90 min compared with 3-4.5 h. Delivery of treatment to a high proportion of patients is possible but requires clinicians to optimise systems for patient transfer, clinical and radiological assessment. A high proportion of patients with stroke already present to UK hospitals within the treatment time window even without specific public awareness or prehospital triage...
June 2010: Practical Neurology
https://www.readbyqxmd.com/read/20219157/effect-of-online-medical-control-on-prehospital-code-stroke-triage
#19
MULTICENTER STUDY
Aikta Verma, David J Gladstone, Jiming Fang, Jordan Chenkin, Sandra E Black, P Richard Verbeek
OBJECTIVE: Prehospital Code Stroke triage has the potential to overwhelm stroke centres by falsely identifying patients as eligible for fibrinolysis. We sought to determine whether online medical control (whereby paramedics contact the medical control physician before a Code Stroke triage is assigned) reduced the proportion of false-positive Code Stroke patients. METHODS: Following the introduction of a protocol for prehospital Code Stroke triage in an urban centre, online medical control alternated with off-line medical control (whereby paramedics implement Code Stroke triage independently) over 4 discreet intervals...
March 2010: CJEM
https://www.readbyqxmd.com/read/19875743/a-citywide-prehospital-protocol-increases-access-to-stroke-thrombolysis-in-toronto
#20
David J Gladstone, Lance H Rodan, Demetrios J Sahlas, Liesly Lee, Brian J Murray, Jon E Ween, James R Perry, Jordan Chenkin, Laurie J Morrison, Shann Beck, Sandra E Black
BACKGROUND AND PURPOSE: Intravenous tissue plasminogen activator for ischemic stroke is approved for eligible patients who can be treated within a 3-hour window, but treatment rates remain disappointingly low, often <5%. To improve rapid access to stroke thrombolysis in Toronto, Canada, a citywide prehospital acute stroke activation protocol was implemented by the provincial government to transport acute stroke patients directly to one of 3 regional stroke centers, bypassing local hospitals...
December 2009: Stroke; a Journal of Cerebral Circulation
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