Abstract 33: FAST-ED Based Pre-Hospital Stroke Triage System Improves Endovascular Treatment Times, Especially off Hours

Abstract

Introduction: Acute stroke outcomes depend on timely reperfusion. In March 2017, the Fire Officers Association of Miami-Dade (FOAMD) implemented the Field Assessment Stroke Triage for Emergency Destination (FAST-ED) scale. Those with a score ≥ 4 bypass other centers for a comprehensive stroke center (CSC) and those with a score ≥ 6 also have the interventional team activated from the field. We analyzed the impact of this initiative on volume, treatment times, outcomes, and distance traveled from scene. Methods: All stroke cases brought to Baptist Hospital of Miami by FOAMD during March 2016 through February 2018 were analyzed, which included a year before and after FAST-ED implementation. Treatment times were compared on vs. off hours and to those with a FAST-ED score ≥6. We used the FAST-ED score documented on the EMS run sheet and a calculated score based on the initial NIHSS. Results: A total of 1153 patients met criteria. Of these, 761 (67%) were coded as stroke (ischemic, hemorrhagic, or TIA), and 235 (20%) underwent reperfusion treatments. Age, sex, race/ethnicity, initial NIHSS, distance traveled, length of stay, door to needle time, and 90 day mRS were comparable between periods (Table). Scale compliance was 85%. Concordance rate of ±1 point between FOAMD and calculated score was 53%. Compared to the previous year, door to groin times (DTG) improved by 17 min (p<0.01) overall, by 25 min (26%) (p<0.001) off-hours only, and by 33 min (31%) (p<0.05) off-hours and calculated FAST-ED ≥ 6. Discussion: The FAST-ED initiative led to faster DTG times. The highest impact is for off-hours with field activation. Only 1 out of 3 activations led to endovascular treatment.