Stroke-Unit and emergency medical service: a 48-month experience in northern Italy

Application effect of prehospital-hospital integrated emergency nursing in patients with acute cerebral infarction

This investigation aimed to elucidate the application impact of prehospital-hospital integrated emergency nursing in individuals with acute cerebral infarction (ACI). Data of 230 ACI patients admitted to our hospital from May 2021 to July 2022 were retrospectively analyzed and divided into A and B groups (AG and BG) according to different nursing methods. The inter-group comparison of the treatment time (time for physician arrival, time for completion of examination, time between admission and thrombolytic therapy, length of stay in emergency) was compared. The success rate of thrombolysis, the inter-group comparison levels of coagulation function indexes [D-dimer (D-D) and fibrinogen (Fbg)], the national Institutes of Health Stroke Scale (NIHSS) score, the Barthel score, family members' self-rating anxiety scale (SAS) score, family members' self-rating depression scale (SDS) score, family satisfaction and adverse reactions were compared between the two groups. The treatment time were reduced in the BG than in the AG (all P < 0.05). The BG had a higher success rate of thrombolysis than the AG (P < 0.05). After the therapy, the D-D level in BG group was higher than that in AG group, and Fbg was lower than that in AG group (both P < 0.05). After nursing, BG's NIHSS score was increased compared with the AG; MBI was reduced (P < 0.05); the SAS and SDS scores of the family members were also reduced (both P < 0.05). The total family satisfaction of the BG (100.00%) was greater than the AG (89.00%) (P < 0.05). The application of prehospital-hospital integrated emergency nursing in ACI patients works effectively.

Does temporary location of ambulances ("fluid deployment") affect response times and patient outcome?

Background

 The objective of this paper is to evaluate the response times and outcome of patients in two groups of patients attended by permanently (PS) and temporarily stationed ambulances (TS) (fluid deployment).

Methods

Patients transported and treated by EMS between March 21, 2012 and March 20, 2013 in a city with 1.7 million inhabitants (Shiraz, Iran) were studied. Using the same number of ambulances, patients were divided into two groups: transported by ambulances dispatched from permanent ambulance stations (PS) vs. dispatched from temporary locations (TS). Furthermore, due to a high discrepancy in the number of missions between PS and TS in this group, a pilot study was also conducted to confirm the first result. The results were statistically analyzed using various methods and compared with regard to mortality and response time.

Results

In this study (both periods), ambulances dispatched from TS had a reduction of their mean response times by 2 min compare to ambulances dispatched from PS. The difference was statistically significant (p < 0.001–[95 % CI, 1.975, 2.025]). The pre-hospital mortality rate was also significantly lower for this group (p = 0.04–[95 % CI, 0.006, 0.012]).

Conclusions

The results of this study suggest that temporary deployment of ambulances reduce response times and may improve early survival rates in patients managed by EMS.

How to improve access to appropriate therapy and outcome of the acute ischemic stroke: a 24-month survey of a specific pre-hospital planning in Northern Italy

Few patients with acute cerebral infarction are medicated with thrombolysis as yet. Thus, a specific plan was created in the area of Bergamo in Northern Italy to increase the number of procedures. The plan, started in 2010, consisted of: (1) subdivision of the area of Bergamo into three zones, each one served by a single Stroke-Unit (SU) licensed to thrombolysis; (2) information to population via newspapers and local broadcasting; and (3) teachings both to personnel of Emergency Medical Service and General Practitioners. Here, we have compared the results of the SU of Policlinico San Marco in the years 2008-2009 versus those in the years 2010-2011. During 2008 and 2009, SU admitted 376 acute ischemic strokes, 60 of whom (16 %) within 3 h of the event. Of those patients, 8 (2 %) were treated with thrombolysis. At 3 months of stroke, 61 patients (16 %) were alive and self-independent. During 2010 and 2011, SU admitted 401 acute ischemic strokes, 91 of whom (22 %) within 3 h of stroke. Of those patients, 23 (6 %) were treated with thrombolysis. At 3 months of stroke, 100 patients were alive and self-independent (25 %). The increases of thrombolytic procedures (p = 0.0171), of self-independent patients (p = 0.0036), and of patients arriving within 3 h of stroke (p = 0.0226) were statistically significant. In conclusion, our study shows that a specific plan increases the numbers of thrombolysis and of self-independent patients at 3 months of stroke.