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Stroke EMS

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...
October 12, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Lauren M Nentwich
Acute ischemic stroke is a challenging and time-sensitive diagnosis. Diagnosis begins with rapid detection of acute stroke symptoms by the patient, their family or caregivers, or bystanders. If acute stroke is suspected, EMS providers should be called for rapid assessment. EMS providers will utilize prehospital stroke tools to diagnose and determine potential stroke severity. Once at the hospital, the stroke team works rapidly to solidify the patient history, perform a focused neurologic examination and obtain necessary laboratory tests and brain imaging to accurately diagnose acute ischemic stroke and properly treat the patient...
November 2016: Emergency Medicine Clinics of North America
O S Mattila, H Harve, S Pihlasviita, J Ritvonen, G Sibolt, M Pystynen, D Strbian, S Curtze, M Kuisma, T Tatlisumak, P J Lindsberg
OBJECTIVES: Blood-based biomarkers could enable early and cost-effective diagnostics for acute stroke patients in the prehospital setting to support early initiation of treatments. To facilitate development of ultra-acute biomarkers, we set out to implement large-scale prehospital blood sampling and determine feasibility and diagnostic timesavings of this approach. MATERIALS AND METHODS: Emergency medical services (EMS) personnel of the Helsinki metropolitan area were trained to collect prehospital blood samples from thrombolysis candidates using a cannula adapter technique...
September 18, 2016: Acta Neurologica Scandinavica
John Gale, Andrew Coburn, Karen Pearson, Zachariah Croll, George Shaler
BACKGROUND: The development of measures to monitor and evaluate the performance and quality of emergency medical services (EMS) systems has been a focus of attention for many years. The Medicare Rural Hospital Flexibility Program (Flex Program), established by Congress in 1997, provides grants to states to implement initiatives to strengthen rural healthcare delivery systems, including better integration of EMS into those systems of care. OBJECTIVE: Building on national efforts to develop EMS performance measures, we sought to identify measures relevant to the rural communities and hospitals supported by the Flex Program...
September 16, 2016: Prehospital Emergency Care
Scott Munro, Sally Rodbard, Khalid Ali, Claire Horsfield, Wendy Knibb, Janet Holah, Ottilia Speirs, Tom Quinn
BACKGROUND: Suspected transient ischaemic attack (TIA) is a common presentation to emergency medical services (EMS) in the United Kingdom (UK). Several EMS systems have adopted the ABCD2 score to aid pre-hospital risk stratification and decision-making on patient disposition, such as direct referral to an Emergency Department or specialist TIA clinic. However, the ABCD2 score, developed for hospital use, has not been validated for use in the pre-hospital context of EMS care. METHODS: We conducted a pilot study to assess eligibility criteria, recruitment rates, protocol compliance, consent and follow-up procedures to inform the development of a definitive study to validate the ABCD2 tool in pre-hospital evaluation of patients with suspected TIA...
2016: Experimental & Translational Stroke Medicine
Koji Furukawa, Takeo Abumiya, Keiji Sakai, Miki Hirano, Toshiya Osanai, Hideo Shichinohe, Naoki Nakayama, Ken Kazumata, Kazutoshi Hida, Kiyohiro Houkin
BACKGROUND AND PURPOSE: High blood viscosity causes blood stagnation and subsequent pathological thrombotic events, resulting in the development of ischemic stroke. We hypothesize that the contribution of blood viscosity may differ among ischemic stroke subtypes based on specific pathological conditions. We tried to verify this hypothesis by measuring blood viscosity in acute ischemic stroke patients using a newly developed electromagnetic spinning sphere (EMS) viscometer. METHODS: Measurements in acute ischemic stroke patients were performed 4 times during admission and data were compared with those obtained from 100 healthy outpatient volunteers...
August 5, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Nwakile Ojike, Joe Ravenell, Azizi Seixas, Alina Masters-Israilov, April Rogers, Girardin Jean-Louis, Gbenga Ogedegbe, Samy I McFarlane
BACKGROUND/AIMS: Stroke is a leading cause of premature death and disability, and increasing the proportion of individuals who are aware of stroke symptoms is a target objective of the Healthy people 2020 project. METHODS: We used data from the 2014 Supplement of the National Health Interview Survey (NHIS) to assess the prevalence of stroke symptom knowledge and awareness. We also tested, using a logistic regression model, the hypothesis that individuals who have knowledge of all 5 stroke symptoms will be have a greater likelihood to activate Emergency Medical Services (EMS) if a stroke is suspected...
April 2016: Journal of Neurology & Neurophysiology
Chong Li, Zoltan Rusak, Imre Horvath, Adrie Kooijman, Linhong Ji
Enhancing engagement of patients during stroke rehabilitation exercises are in the focus of current research. Various methods and computer supported tools have been developed for this purpose, which try to avoid mundane exercising that is prone to become a routine or even boring for the patients and leads to ineffective training. This paper introduces an engagement enhancing cyber-physical stroke rehabilitation system (CP-SRS) aiming at enhancing the patient's engagement during rehabilitation training exercises...
July 13, 2016: IEEE Transactions on Neural Systems and Rehabilitation Engineering
Bin Jiang, Xiaojuan Ru, Haixin Sun, Hongmei Liu, Dongling Sun, Yunhai Liu, Jiuyi Huang, Li He, Wenzhi Wang
This study aimed to explore pre-hospital delay and its associated factors in first-ever stroke registered in communities from three cities in China. The rates of delay greater than or equal to 2 hours were calculated and factors associated with delays were determined by non-conditional binary logistic regression, after adjusting for different explanatory factors. Among the 403 cases of stroke with an accurate documented time of prehospital delay, the median time (interquartile range) was 4.00 (1.50-14.00) hours...
2016: Scientific Reports
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
Syed F Zaidi, Julie Shawver, Aixa Espinosa Morales, Hisham Salahuddin, Gretchen Tietjen, David Lindstrom, Brent Parquette, Andrea Adams, Andrea Korsnack, Mouhammad A Jumaa
BACKGROUND: Early identification and transfer of patients with acute stroke to a primary or comprehensive stroke center results in favorable outcomes. OBJECTIVE: To describe implementation and results of an emergency medical service (EMS)-driven stroke protocol in Lucas County, Ohio. METHOD: All county EMS personnel (N=464) underwent training in the Rapid Arterial oCclusion Evaluation (RACE) score. The RACE Alert (RA) protocol, whereby patients with stroke and a RACE score ≥5 were taken to a facility that offered advanced therapy, was implemented in July 2015...
June 24, 2016: Journal of Neurointerventional Surgery
Alice Le Bonniec, Julie Haesebaert, Laurent Derex, Sylvie Porthault, Marie Préau, Anne-Marie Schott
BACKGROUND: Despite national and local French information campaigns, when acute stroke occurs, waiting times before calling mobile emergency medical services (EMS) to receive appropriate treatment (i.e. thrombolysis) and decrease the risk of physical disability, remain long. We aimed to identify the representations of stroke in the general population and to determine barriers to and facilitators for rapidly contacting EMS. METHOD: We conducted a qualitative study among the general population with 10 focus groups, 5 comprising employed people (N = 29) and 5 comprising retirees (N = 32)...
2016: PloS One
Jeff J Clawson, Greg Scott, Isabel Gardett, Scott Youngquist, Peter Taillac, Conrad Fivaz, Christopher Olola
BACKGROUND: Early hospital notification of a possible stroke arriving via emergency medical services (EMS) can prepare stroke center personnel for timely treatment, especially timely administration of tissue plasminogen activator. Stroke center notification from the emergency dispatch center-before responders reach the scene-may promote even earlier and faster system activation, meaning that stroke center teams may be ready to receive patients as soon as the ambulance arrives. This study evaluates the use of a Medical Priority Dispatch System (MPDS; Priority Dispatch Corp...
August 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
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)...
May 31, 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
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
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
B O Feng, Wei Wu, Hua Wang, Junchen Wang, Dongya Huang, Ling Cheng
The side-to-side difference in bone mineral content and soft tissue composition of extremities and their associations have been observed in patients with stroke and the results are inconsistent. The aim of the present study was to investigate the interaction between bone mineral content (BMC), lean mass (LM) and fat mass (FM) in the paretic extremities in patients following stroke and to determine the effectiveness of electrical muscle stimulation (EMS) following sciatic neurectomy (SN) in rats. BMC, LM and FM were measured by dual-energy X-ray absorptiometry in 61 hemiplegic patients following stroke...
May 2016: Biomedical Reports
Ming-Ju Hsieh, Sung-Chun Tang, Wen-Chu Chiang, Li-Kai Tsai, Jiann-Shing Jeng, Matthew Huei-Ming Ma
BACKGROUND: The sooner thrombolytic therapy is given to acute ischemic stroke patients, the better the outcome. Prehospital notification may shorten the time between hospital arrival and brain computed tomography (door-to-CT) and the door-to-needle (DTN) time. This study investigated the effect of prehospital notification on acute stroke care in an urban city in Taiwan. METHODS: This retrospective observational study utilized a prospectively collected dataset from patients treated at 9 hospitals and the emergency medical service (EMS) system in Taipei City from September 1, 2012 to December 31, 2014...
2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
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