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McClelland G, Burrow E, Alton A, Shaw L, Finch T, Price C. What factors contribute towards ambulance on-scene times for suspected stroke patients? An observational study. Eur Stroke J 2023; 8:492-500. [PMID: 37231700 PMCID: PMC10334177 DOI: 10.1177/23969873231163290] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/24/2023] [Indexed: 12/07/2023] Open
Abstract
INTRODUCTION Pre-hospital stroke care focusses on rapid access to specialist stroke units, but UK ambulance data shows increasing pre-hospital times. This study aimed to describe factors contributing towards ambulance on-scene times (OST) for suspected stroke patients and identify targets for a future intervention. PATIENTS AND METHODS Ambulance clinicians in North East Ambulance Service were asked to complete a survey after transporting any suspected stroke patients to describe the patient encounter, interventions and timings. Completed surveys were linked with electronic patient care records. Potentially modifiable factors were identified by the study team. Poisson regression analysis quantified the association of selected potentially modifiable factors with OST. RESULTS About 2037 suspected stroke patients were conveyed between July and December 2021, resulting in 581 fully completed surveys by 359 different clinicians. The median age of patients was 75 years (interquartile range (IQR) 66-83) and 52% of patients were male. Median OST was 33 min (IQR 26-41). Three potentially modifiable factors were identified as contributors to extended OST. Performing additional advanced neurological assessments added 10% to OST (34 vs 31 min, p = 0.008); intravenous cannulation added 13% (35 vs 31 min, p = <0.001) and ECGs added 22% (35 vs 28 min, p = <0.001). CONCLUSIONS This study identified three potentially modifiable factors that increased pre-hospital OST with suspected stroke patients. This type of data can be used to target interventions at behaviours that extend pre-hospital OST but which have questionable patient benefit. This approach will be evaluated in a follow up study in the North East of England.
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Affiliation(s)
- Graham McClelland
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Emma Burrow
- North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Abi Alton
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Lisa Shaw
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tracy Finch
- Department of Nursing, Midwifery & Health, Northumbria University, Newcastle upon Tyne, UK
| | - Chris Price
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Li T, Koloden D, Berkowitz J, Luo D, Luan H, Gilley C, Kurgansky G, Barbara P. Prehospital transport and termination of resuscitation of cardiac arrest patients: A review of prehospital care protocols in the United States. Resusc Plus 2023; 14:100397. [PMID: 37252026 PMCID: PMC10213088 DOI: 10.1016/j.resplu.2023.100397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/26/2023] [Accepted: 04/29/2023] [Indexed: 05/31/2023] Open
Abstract
Background The objective was to describe emergency medical services (EMS) protocol variability in transport expectations for out-of-hospital cardiac arrest (OHCA) patients and the involvement of online medical control for on-scene termination of resuscitation in the United States. Whether other aspects of OHCA care were mentioned, including the definition of a "pediatric" patient, and use of end-tidal carbon dioxide monitoring, mechanical chest compression devices (MCCDs), and extracorporeal membrane oxygenation (ECMO), were also described. Methods and Results Review of EMS protocols publicly accessible from https://www.emsprotocols.org and through searches on the internet when protocols were unavailable on the website from June 2021 to January 2022. Frequencies and proportions were used to describe outcomes. Of 104 protocols reviewed, 51.9% state to initiate transport after return of spontaneous circulation (ROSC), 26.0% do not specify when to initiate transport, and 6.7% state to transport after ≥20 minutes of on-scene cardiopulmonary resuscitation for adults. For pediatric patients, 38.5% of protocols do not specify when to initiate transport, 32.7% state to transport after ROSC, and 10.6% state to transport as soon as possible. Most protocols (42.3%) did not specify the age that defines "pediatric" in cardiac arrest. More than half (51.9%) of the protocols require online medical control for termination of resuscitation. Most protocols mention the use of end-tidal carbon dioxide monitoring (81.7%), 50.0% mention the use of MCCDs, and 4.8% mention ECMO for cardiac arrest. Conclusions In the United States, EMS protocols for initiation of transport and termination of resuscitation for OHCA patients are highly variable.
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Affiliation(s)
- Timmy Li
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY, USA
| | - Daniel Koloden
- Center for Emergency Medical Services, Northwell Health, 15 Burke Lane, Syosset, NY, USA
| | - Jonathan Berkowitz
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY, USA
- Center for Emergency Medical Services, Northwell Health, 15 Burke Lane, Syosset, NY, USA
| | - Dee Luo
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY, USA
| | - Howard Luan
- Feinstein Institutes for Medical Research, Northwell Health, 350 Community Drive, Manhasset, NY, USA
| | - Charles Gilley
- Feinstein Institutes for Medical Research, Northwell Health, 350 Community Drive, Manhasset, NY, USA
| | - Gregory Kurgansky
- Feinstein Institutes for Medical Research, Northwell Health, 350 Community Drive, Manhasset, NY, USA
| | - Paul Barbara
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY, USA
- Center for Emergency Medical Services, Northwell Health, 15 Burke Lane, Syosset, NY, USA
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Farcas AM, Joiner AP, Rudman JS, Ramesh K, Torres G, Crowe RP, Curtis T, Tripp R, Bowers K, von Isenburg M, Logan R, Coaxum L, Salazar G, Lozano M, Page D, Haamid A. Disparities in Emergency Medical Services Care Delivery in the United States: A Scoping Review. PREHOSP EMERG CARE 2022; 27:1058-1071. [PMID: 36369725 DOI: 10.1080/10903127.2022.2142344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 10/25/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Emergency medical services (EMS) often serve as the first medical contact for ill or injured patients, representing a critical access point to the health care delivery continuum. While a growing body of literature suggests inequities in care within hospitals and emergency departments, limited research has comprehensively explored disparities related to patient demographic characteristics in prehospital care. OBJECTIVE We aimed to summarize the existing literature on disparities in prehospital care delivery for patients identifying as members of an underrepresented race, ethnicity, sex, gender, or sexual orientation group. METHODS We conducted a scoping review of peer-reviewed and non-peer-reviewed (gray) literature. We searched PubMed, CINAHL, Web of Science, Proquest Dissertations, Scopus, Google, and professional websites for studies set in the U.S. between 1960 and 2021. Each abstract and full-text article was screened by two reviewers. Studies written in English that addressed the underrepresented groups of interest and investigated EMS-related encounters were included. Studies were excluded if a disparity was noted incidentally but was not a stated objective or discussed. Data extraction was conducted using a standardized electronic form. Results were summarized qualitatively using an inductive approach. RESULTS One hundred forty-five full-text articles from the peer-reviewed literature and two articles from the gray literature met inclusion criteria: 25 studies investigated sex/gender, 61 studies investigated race/ethnicity, and 58 studies investigated both. One study investigated sexual orientation. The most common health conditions evaluated were out-of-hospital cardiac arrest (n = 50), acute coronary syndrome (n = 36), and stroke (n = 31). The phases of EMS care investigated included access (n = 55), pre-arrival care (n = 46), diagnosis/treatment (n = 42), and response/transport (n = 40), with several studies covering multiple phases. Disparities were identified related to all phases of EMS care for underrepresented groups, including symptom recognition, pain management, and stroke identification. The gray literature identified public perceptions of EMS clinicians' cultural competency and the ability to appropriately care for transgender patients in the prehospital setting. CONCLUSIONS Existing research highlights health disparities in EMS care delivery throughout multiple health outcomes and phases of EMS care. Future research is needed to identify structured mechanisms to eliminate disparities, address clinician bias, and provide high-quality equitable care for all patient populations.
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Affiliation(s)
- Andra M Farcas
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Anjni P Joiner
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Jordan S Rudman
- Harvard Affiliated Emergency Medicine Residency, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Karthik Ramesh
- School of Medicine, University of California San Diego, San Diego, California
| | | | | | | | - Rickquel Tripp
- Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Karen Bowers
- Atlanta Fire Rescue Department; Department of Emergency Medicine, University of Tennessee-Chattanooga, Chattanooga, Tennessee
| | - Megan von Isenburg
- Duke University Medical Center Library, Duke University, Durham, North Carolina
| | - Robert Logan
- San Diego Fire - Rescue Department, San Diego, California
| | - Lauren Coaxum
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Michael Lozano
- Division of Emergency Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - David Page
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Ameera Haamid
- Section of Emergency Medicine, University of Chicago School of Medicine, Chicago, Illinois
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4
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Gunn J. Do methods of hospital pre-alerts influence the on-scene times for acute pre-hospital stroke patients? A retrospective observational study. Br Paramed J 2021; 6:19-25. [PMID: 34539251 PMCID: PMC8415206 DOI: 10.29045/14784726.2021.9.6.2.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Stroke is one of the leading causes of death and disability worldwide. The ambulance service is often the first medical service to reach an acute stroke patient, and due to the time-critical nature of stroke, a time-critical assessment and rapid transport to a hyper acute stroke unit are essential. As stroke services have been centralised, different hospitals have implemented different pre-alert admission policies that may affect the on-scene time of the attending ambulance crew. The aim of this study is to investigate if the different pre-alert admission policies affect time on scene. METHOD The current study is a retrospective quantitative observational study using data routinely collected by North East Ambulance Service NHS Foundation Trust. The time on scene was divided into two variables; group one was a telephone pre-alert in which a telephone discussion with the receiving hospital is required before they accept admission of the patient. Group two was a radio-style pre-alert in which the attending clinician makes an autonomous decision on the receiving hospital and alerts them via a short radio message of the incoming patient. These times were then compared to identify if there was any difference between them. RESULTS Data on 927 patients over a three-month period, from October to December 2019, who had received the full stroke bundle of care, were within the thrombolysis window and recorded as a stroke by the attending clinician, were split into the variable groups and reported on. The mean time on scene for a telephone call pre-alert was 33 minutes and 19 seconds, with a standard deviation of 13 minutes and 8 seconds. The mean on-scene time for a radio pre-alert was 28 minutes and 24 seconds, with a standard deviation of 11 minutes and 51 seconds. CONCLUSION A pre-alert given via radio instead of via telephone is shown to have a mean time saving of 4 minutes and 55 seconds, representing an important decrease in time which could be beneficial to patients.
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Schott AM, Termoz A, Viprey M, Tazarourte K, Vecchia CD, Bravant E, Perreton N, Nighoghossian N, Cakmak S, Meyran S, Ducreux B, Pidoux C, Bony T, Douplat M, Potinet V, Sigal A, Xue Y, Derex L, Haesebaert J. Short and long-term impact of four sets of actions on acute ischemic stroke management in Rhône County, a population based before-and-after prospective study. BMC Health Serv Res 2021; 21:12. [PMID: 33397363 PMCID: PMC7783982 DOI: 10.1186/s12913-020-05982-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 11/27/2020] [Indexed: 11/17/2022] Open
Abstract
Background Optimizing access to recanalization therapies in acute ischemic stroke patients is crucial. Our aim was to measure the short and long term effectiveness, at the acute phase and 1 year after stroke, of four sets of actions implemented in the Rhône County. Methods The four multilevel actions were 1) increase in stroke units bed capacity and development of endovascular therapy; 2) improvement in knowledge and skills of healthcare providers involved in acute stroke management using a bottom-up approach; 3) development and implementation of new organizations (transportation routes, pre-notification, coordination by the emergency call center physician dispatcher); and 4) launch of regional public awareness campaigns in addition to national campaigns. A before-and-after study was conducted with two identical population-based cohort studies in 2006–7 and 2015–16 in all adult ischemic stroke patients admitted to any emergency department or stroke unit of the Rhône County. The primary outcome criterion was in-hospital management times, and the main secondary outcome criteria were access to reperfusion therapy (either intravenous thrombolysis or endovascular treatment) and pre-hospital management times in the short term, and 12-month prognosis measured by the modified Rankin Scale (mRS) in the long term. Results Between 2015–16 and 2006–7 periods ischemic stroke patients increased from 696 to 717, access to reperfusion therapy increased from 9 to 23% (p < 0.0001), calls to emergency call-center from 40 to 68% (p < 0.0001), first admission in stroke unit from 8 to 30% (p < 0.0001), and MRI within 24 h from 18 to 42% (p < 0.0001). Onset-to-reperfusion time significantly decreased from 3h16mn [2 h54-4 h05] to 2h35mn [2 h05-3 h19] (p < 0.0001), mainly related to a decrease in delay from admission to imaging. A significant decrease of disability was observed, as patients with mild disability (mRS [0–2]) at 12 months increased from 48 to 61% (p < 0.0001). Pre-hospital times, however, did not change significantly. Conclusions We observed significant improvement in access to reperfusion therapy, mainly through a strong decrease of in-hospital management times, and in 12-month disability after the implementation of four sets of actions between 2006 and 2016 in the Rhône County. Reducing pre-hospital times remains a challenge.
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Affiliation(s)
- A M Schott
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, 8 Avenue Rockefeller, 69008, Lyon, France. .,Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France.
| | - A Termoz
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, 8 Avenue Rockefeller, 69008, Lyon, France.,Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - M Viprey
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, 8 Avenue Rockefeller, 69008, Lyon, France.,Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - K Tazarourte
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, 8 Avenue Rockefeller, 69008, Lyon, France.,Emergency Department - HEH, Hospices Civils de Lyon, Lyon, France
| | - C Della Vecchia
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, 8 Avenue Rockefeller, 69008, Lyon, France
| | - E Bravant
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, 8 Avenue Rockefeller, 69008, Lyon, France.,Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - N Perreton
- Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - N Nighoghossian
- Hospices Civils de Lyon, Comprehensive Stroke Center, Hôpital Pierre Wertheimer, Bron, France
| | - S Cakmak
- Hôpital Nord Ouest, Primary Stroke Center, Villefranche-sur-Saône, France
| | - S Meyran
- Emergency Department, Hôpital St Joseph St Luc, Lyon, France
| | - B Ducreux
- Emergency Department, Hôpital Nord Ouest, Villefranche-sur-Saône, France
| | - C Pidoux
- Emergency Department, Hôpital Nord Ouest, Villefranche-sur-Saône, France
| | - T Bony
- Emergency Department, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre Bénite, France
| | - M Douplat
- Emergency Department, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre Bénite, France
| | - V Potinet
- Emergency Department, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre Bénite, France
| | - A Sigal
- Emergency Department, Hospices Civils de Lyon, Hôpital Croix Rousse, Lyon, France
| | - Y Xue
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, 8 Avenue Rockefeller, 69008, Lyon, France.,Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - L Derex
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, 8 Avenue Rockefeller, 69008, Lyon, France.,Hospices Civils de Lyon, Comprehensive Stroke Center, Hôpital Pierre Wertheimer, Bron, France
| | - J Haesebaert
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, 8 Avenue Rockefeller, 69008, Lyon, France.,Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
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Li T, Cushman JT, Shah MN, Kelly AG, Rich DQ, Jones CMC. Prehospital time intervals and management of ischemic stroke patients. Am J Emerg Med 2020; 42:127-131. [PMID: 32059935 DOI: 10.1016/j.ajem.2020.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/06/2020] [Accepted: 02/06/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Quantify prehospital time intervals, describe prehospital stroke management, and estimate potential time saved if certain procedures were performed en route to the emergency department (ED). METHODS Acute ischemic stroke patients who arrived via emergency medical services (EMS) between 2012 and 2016 were identified. We determined the following prehospital time intervals: chute, response, on-scene, transport, and total prehospital times. Proportions of patients receiving the following were determined: Cincinnati Prehospital Stroke Scale (CPSS) assessment, prenotification, glucose assessment, vascular access, and 12-lead electrocardiography (ECG). For glucose assessment, ECG acquisition, and vascular access, the location (on-scene vs. en route) in which they were performed was described. Difference in on-scene times among patients who had these three interventions performed on-scene vs. en route was assessed. RESULTS Data from 870 patients were analyzed. Median total prehospital time was 39 min and comprised the following: chute time: 1 min; response time: 9 min; on-scene time: 15 min; and transport time: 14 min. CPSS was assessed in 64.7% of patients and prenotification was provided for 52.0% of patients. Glucose assessment, vascular access initiation, and ECG acquisition was performed on 84.1%, 72.6%, and 67.2% of patients, respectively. 59.0% of glucose assessments, 51.2% of vascular access initiations, and 49.8% of ECGs were performed on-scene. On-scene time was 9 min shorter among patients who had glucose assessments, vascular access initiations, and ECG acquisitions all performed en route vs. on-scene. CONCLUSIONS On-scene time comprised 38.5% of total prehospital time. Limiting on-scene performance of glucose assessments, vascular access initiations, and ECG acquisitions may decrease prehospital time.
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Affiliation(s)
- Timmy Li
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States of America.
| | - Jeremy T Cushman
- Department of Emergency Medicine, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States of America; Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States of America
| | - Manish N Shah
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Adam G Kelly
- Department of Neurology, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States of America
| | - David Q Rich
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States of America; Department of Medicine, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States of America; Department of Environmental Medicine, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States of America
| | - Courtney M C Jones
- Department of Emergency Medicine, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States of America; Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States of America
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Haworth D, McClelland G. Call to hospital times for suspected stroke patients in the North East of England: a service evaluation. Br Paramed J 2019; 4:31-36. [PMID: 33328834 PMCID: PMC7706759 DOI: 10.29045/14784726.2019.09.4.2.31] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction: Stroke is a leading cause of mortality and morbidity. The role of the ambulance service in acute stroke care focuses on recognition followed by rapid transport to specialist care. The treatment options for acute ischaemic strokes are time dependent, so minimising the pre-hospital phase of care is important. The aim of this service evaluation was to report historical pre-hospital times for suspected stroke patients transported by the North East Ambulance Service NHS Foundation Trust (NEAS) and identify areas for improvement. Methods: This was a retrospective service evaluation using routinely collected data. Data on overall call to hospital times, call to arrival times, on scene times and leave scene to hospital are reported. Results: Data on 24,070 patients with an impression of stroke transported by NEAS between 1 April 2011 and 31 May 2018 are reported. The median call to hospital time increased from 41 to 68 minutes, call to arrival from 7 to 17 minutes, on scene from 20 to 30 minutes and leave to hospital from 12 to 15 minutes. Conclusion: The pre-hospital call to hospital time for stroke patients increased between 2011 and 2018. The call to arrival phase saw a sharp increase between 2015 and 2017, whereas on scene and leave scene to hospital saw steadier increases. Increasing demand on the ambulance service, reorganisation of regional stroke services and other factors may have contributed to the increase in times. Reducing the on scene phase of pre-hospital stroke care would lead to patient benefits and is the area where ambulance clinicians have the most influence.
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Affiliation(s)
- Daniel Haworth
- North East Ambulance Service NHS Foundation Trust: ORCID iD: https://orcid.org/0000-0003-0334-3300
| | - Graham McClelland
- North East Ambulance Service NHS Foundation Trust: ORCID iD: https://orcid.org/0000-0002-4502-5821
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8
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Wang Z, Ding Y, Fu P. Prehospital stroke care, a narrative review. Brain Circ 2019; 4:160-164. [PMID: 30693342 PMCID: PMC6329213 DOI: 10.4103/bc.bc_31_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 11/20/2018] [Accepted: 11/26/2018] [Indexed: 12/19/2022] Open
Abstract
Stroke is a leading cause of disability in the United States and current treatment for stroke is limited to two modalities with well-defined time restraints. The prehospital setting is a significant and relatively easy setting for innovation in stroke care, as the most clinical decisions are made within the first several hours of symptom onset. In this review, we look at recent innovations in improving prehospital care for acute stroke including the conception of mobile stroke units, the ongoing development of stroke models for emergency providers, barriers to prehospital care, and the innovation of new telephone applications. Although there are notable improvements in acute stroke care, additional research is needed to further improve on current models and technologies.
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Affiliation(s)
- Zi Wang
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Yuchuan Ding
- Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Paul Fu
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
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