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Stroke EMS

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https://www.readbyqxmd.com/read/29023166/prehospital-stroke-assessment-for-large-vessel-occlusions-a-systematic-review
#1
William Krebs, Travis P Sharkey-Toppen, Fern Cheek, Eric Cortez, Ashley Larrimore, David Keseg, Ashish R Panchal
BACKGROUND AND OBJECTIVE: Stroke is the leading cause of disability in the United States and new evidence shows interventional procedures provide better outcomes for large vessel occlusions (LVO). We performed a systematic review of the literature on prehospital stroke scales used to identify LVOs comparing the scales with analysis of the sensitivity, specificity, and predictive values. The goal was to determine if emergency medical services (EMS) are able to accurately identify LVO in the field...
October 12, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28975971/the-relationship-between-serum-cxcl16-level-and-carotid-vulnerable-plaque-in-patients-with-ischemic-stroke
#2
G Jin
OBJECTIVE: We investigated the relationship between the serum macrophage chemokine ligand 16 (CXCL16) levels and the vulnerable carotid plaque in patients with ischemic stroke. PATIENTS AND METHODS: We successively selected 118 cases of patients with an initial diagnosis of acute ischemic stroke (time of onset < 72 h), recorded risk factors, including gender, age, family history, smoking, body mass index, blood glucose levels, blood lipid levels, average systolic pressure and diastolic blood pressure (DBP) and homocysteine levels...
October 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/28959230/accuracy-of-emergency-medical-services-dispatcher-and-crew-diagnosis-of-stroke-in-clinical-practice
#3
Judy Jia, Roger Band, Michael E Abboud, William Pajerowski, Michelle Guo, Guy David, C Crawford Mechem, Steven R Messé, Brendan G Carr, Michael T Mullen
BACKGROUND: Accurate recognition of stroke symptoms by Emergency Medical Services (EMS) is necessary for timely care of acute stroke patients. We assessed the accuracy of stroke diagnosis by EMS in clinical practice in a major US city. METHODS AND RESULTS: Philadelphia Fire Department data were merged with data from a single comprehensive stroke center to identify patients diagnosed with stroke or TIA from 9/2009 to 10/2012. Sensitivity and positive predictive value (PPV) were calculated...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28936069/prehospital-management-of-acute-stroke-in-rural-versus-urban-responders
#4
Gregory Hansen, Simerpreet Bal, Kerri Lynn Schellenberg, Susan Alcock, Esseddeeg Ghrooda
OBJECTIVE: Stroke guideline compliance of rural Canadian prehospital emergency medical services (EMS) care in acute stroke is unknown. In this quality assurance study, we sought to compare rural and urban care by prehospital EMS evaluation/management indicators from patients assessed at an urban Canadian stroke center. MATERIALS AND METHODS: One hundred adult patients were randomly selected from the stroke registry. Patients were transported through Rural EMS bypass protocols or urban EMS protocols (both bypass and direct) to our stroke center between January and December 2013...
August 2017: Journal of Neurosciences in Rural Practice
https://www.readbyqxmd.com/read/28900664/-prehospital-care-for-stroke-patients
#5
REVIEW
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...
September 12, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28864702/design-and-validation-of-a-clinical-scale-for-prehospital-stroke-recognition-severity-grading-and-prediction-of-large-vessel-occlusion-the-shortened-nih-stroke-scale-for-emergency-medical-services
#6
Jan Christoph Purrucker, Florian Härtig, Hardy Richter, Andreas Engelbrecht, Johannes Hartmann, Jonas Auer, Christian Hametner, Erik Popp, Peter Arthur Ringleb, Simon Nagel, Sven Poli
OBJECTIVE: To develop an NIH Stroke Scale (NIHSS)-compatible, all-in-one scale for rapid and comprehensive prehospital stroke assessment including stroke recognition, severity grading and progression monitoring as well as prediction of large vessel occlusion (LVO). METHODS: Emergency medical services (EMS) personnel and stroke physicians (n=326) rated each item of the NIHSS regarding suitability for prehospital use; best rated items were included. Stroke recognition was evaluated retrospectively in 689 consecutive patients with acute stroke or stroke mimics, prediction of LVO in 741 consecutive patients with ischaemic stroke with acute vessel imaging independent of admission NIHSS score...
September 1, 2017: BMJ Open
https://www.readbyqxmd.com/read/28862480/national-characteristics-of-emergency-medical-services-responses-for-older-adults-in-the-united-states
#7
Hieu V Duong, Lauren Nicholas Herrera, Justin Xavier Moore, John Donnelly, Karen E Jacobson, Jestin N Carlson, N Clay Mann, Henry E Wang
OBJECTIVE: Older adults, those aged 65 and older, frequently require emergency care. However, only limited national data describe the Emergency Medical Services (EMS) care provided to older adults. We sought to determine the characteristics of EMS care provided to older adults in the United States. METHODS: We used data from the 2014 National Emergency Medical Services Information System (NEMSIS), encompassing EMS response data from 46 States and territories. We excluded EMS responses for children <18 years, interfacility transports, intercepts, non-emergency medical transports, and standby responses...
September 1, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28841085/observational-multicenter-study-of-a-direct-to-ct-protocol-for-ems-transported-patients-with-suspected-stroke
#8
David C Cone, Craig Cooley, Jeffrey Ferguson, Andrew J Harrell, Jeffrey H Luk, Christian Martin-Gill, Sean W Marquis, Scott Pasichow
OBJECTIVE: In an effort to decrease door-to-needle times for patients with acute ischemic stroke, some hospitals have begun taking stable EMS patients with suspected stroke directly from the ambulance to the CT scanner, then to an emergency department (ED) bed for evaluation. Minimal data exist regarding the potential for time savings with such a protocol. The study hypothesis was that a direct-to-CT protocol would be associated with decreases in both door-to-CT-ordered and door-to-needle times...
August 25, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28813914/data-sample-size-needed-for-analysis-of-kinematic-and-muscle-synergies-in-healthy-and-stroke-populations
#9
Navid Lambert-Shirzad, H F Machiel Van der Loos
Multiple studies have suggested the central nervous system (CNS) generates motions by using modular control of muscles and joints (synergies). However, the synergies reported by these studies are task dependent and might not reflect the true control strategies adopted by the CNS. Studying exploratory motions (EMs) can reveal biomechanical constraints and motor control strategies in healthy and clinical populations. The first logical step to consider EMs in study of motor synergies is to determine how much data is required to reliably and fully profile the motion patterns of an individual...
July 2017: IEEE ... International Conference on Rehabilitation Robotics: [proceedings]
https://www.readbyqxmd.com/read/28804875/prehospital-pathways-of-occipital-stroke-patients-with-mainly-visual-symptoms
#10
S Räty, K Silvennoinen, T Tatlisumak
OBJECTIVES: Occipital ischemic strokes typically cause homonymous visual field defects, for which means of rehabilitation are limited. Intravenous thrombolysis is increasingly and successfully used for their acute treatment. However, recognition of strokes presenting with mainly visual field defects is challenging for both patients and healthcare professionals. We studied prehospital pathways of occipital stroke patients with mainly visual symptoms to define obstacles in their early recognition...
August 13, 2017: Acta Neurologica Scandinavica
https://www.readbyqxmd.com/read/28683821/stroke-awareness-among-dubai-emergency-medical-service-staff-and-impact-of-an-educational-intervention
#11
Fatima Shire, Zahra Kasim, Suhail Alrukn, Maria Khan
BACKGROUND: Emergency medical services (EMS) play a vital role in expediting hospital arrival in stroke patients. The objective of our study was to assess the level of awareness regarding pre-hospital identification and management of acute stroke among EMS Staff in Dubai and to evaluate the impact of an educational lecture on their knowledge. METHODS: Ours was a cross-sectional study with a pre-test and post-test design. The intervention was an educational lecture, based on the updated guidelines in pre-hospital care of acute stroke...
July 6, 2017: BMC Research Notes
https://www.readbyqxmd.com/read/28646851/development-of-an-education-campaign-to-reduce-delays-in-pre-hospital-response-to-stroke
#12
Caterina Caminiti, Peter Schulz, Barbara Marcomini, Elisa Iezzi, Silvia Riva, Umberto Scoditti, Andrea Zini, Giovanni Malferrari, Maria Luisa Zedde, Donata Guidetti, Enrico Montanari, Mario Baratti, Licia Denti
BACKGROUND: Systematic reviews call for well-designed trials with clearly described intervention components to support the effectiveness of educational campaigns to reduce patient delay in stroke presentation. We herein describe the systematic development process of a campaign aimed to increase stroke awareness and preparedness. METHODS: Campaign development followed Intervention Mapping (IM), a theory- and evidence-based tool, and was articulated in two phases: needs assessment and intervention development...
June 24, 2017: BMC Emergency Medicine
https://www.readbyqxmd.com/read/28641984/bi-objective-approach-for-placing-ground-and-air-ambulance-base-and-helipad-locations-in-order-to-optimize-ems-response
#13
Milad Shahriari, Ali Bozorgi-Amiri, Shayan Tavakoli, Abolghasem Yousefi-Babadi
Shortening the travel time of patient transfer has clinical implications for many conditions such as cardiac arrest, trauma, stroke and STEMI. As resources are often limited precise calculations are needed. In this paper we consider the location problem for both ground and aerial emergency medical services. Given the uncertainty of when patients are in need of prompt medical attention we consider these demand points to be uncertain. We consider various ways in which ground and helicopter ambulances can work together to make the whole process go faster...
June 15, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28622073/neighborhood-poverty-and-9-1-1-ambulance-contacts
#14
Josh Seim, Joshua English, Karl Sporer
BACKGROUND: Neighborhood poverty is positively associated with frequency of 9-1-1 ambulance utilization, but it is unclear whether this association remains significant when accounting for variations in the severities and types of ambulance contacts. METHODS: We merged EMS ambulance contact records in a single California county (n = 88,027) with data from the American Community Survey at the census tract level (n = 300). Using tract as a proxy for neighborhood and negative binomial regression as an analytical tool, we predicted 16 outcomes: any ambulance contacts, ambulance contacts stratified by three intervention severities, and ambulance contacts varied by 12 primary impression categories...
June 16, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28615192/access-to-hyperacute-stroke-services-across-canadian-provinces-a-geospatial-analysis
#15
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
https://www.readbyqxmd.com/read/28536170/door-to-needle-delays-in-minor-stroke-a-causal-inference-approach
#16
Sara K Rostanski, Zachary Shahn, Mitchell S V Elkind, Ava L Liberman, Randolph S Marshall, Joshua I Stillman, Olajide Williams, Joshua Z Willey
BACKGROUND AND PURPOSE: Thrombolysis rates among minor stroke (MS) patients are increasing because of increased recognition of disability in this group and guideline changes regarding treatment indications. We examined the association of delays in door-to-needle (DTN) time with stroke severity. METHODS: We performed a retrospective analysis of all stroke patients who received intravenous tissue-type plasminogen activator in our emergency department between July 1, 2011, and February 29, 2016...
July 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28499678/saving-lives-for-35-years-sentara-nightingale-looks-forward
#17
Dale Gauding
The Nightingale Regional air Ambulance program, operated by Norfolk, VA-based not-for-profit Sentara Healthcare, is marking its 35th year of operation in 2017, having surpassed 20,000 safe flights. Looking ahead, the program is adding IFR capabilities, designated landing zones to rendezvous with EMS partners and clinical training in a simulation lab, and collaborating with cardiac and neurology services to provide quicker interventions for STEMI and stroke patients at Sentara Norfolk General Hospital.
May 2017: Air Medical Journal
https://www.readbyqxmd.com/read/28485255/a-system-based-intervention-to-improve-access-to-hyperacute-stroke-care
#18
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
https://www.readbyqxmd.com/read/28457621/validation-of-the-national-institutes-of-health-stroke-scale-8-to-detect-large-vessel-occlusion-in-ischemic-stroke
#19
Jelle Demeestere, Carlos Garcia-Esperon, Longting Lin, Andrew Bivard, Timothy Ang, Nicolas R Smoll, Ashley Garnett, Allan Loudfoot, Ferdi Miteff, Neil Spratt, Mark Parsons, Christopher Levi
BACKGROUND: Patients with acute ischemic stroke and large vessel occlusion (LVO) may benefit from prehospital identification and transfer to a center offering endovascular therapy. AIMS: We aimed to assess the accuracy of an existing 8-item stroke scale (National Institutes of Health Stroke Scale-8 [NIHSS-8]) for identification of patients with acute stroke with LVO. METHODS: We retrospectively calculated NIHSS-8 scores in a population of consecutive patients with presumed acute stroke assessed by emergency medical services (EMS)...
July 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28439183/race-ethnic-disparities-in-hospital-arrival-time-after-ischemic-stroke
#20
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
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