Abstract T P349: Pre-Hospital Notification by Emergency Medical Services and Improved Stroke Care

Abstract

Background: In rural settings, distance is a factor when medical assistance is critical. Every minute can make a difference in treatment and recovery of a stroke patient. Early recognition and notification of a possible stroke are key elements in the chain of survival for stroke victims. Emergency Medical Services (EMS) involvement in pre-hospital notification of a stroke patient can improve assessment and diagnostic times and use of alteplase. Purpose: The purpose of this study was to compare times of specific assessments, diagnostics, and treatments with EMS stroke alert activation prior to arrival compared to stroke alert activation by hospital personnel after patient arrival. Methods: In the setting of a rural, community hospital, the local fire department/paramedics were trained to use a screening tool and to provide pre-hospital activation of a stroke alert. The trial demonstrated positive results. Subsequently, education was disseminated to EMS providers throughout the five county service area. Data was collected from January to December 2013, with 30 alerts activated by Emergency Department (ED) personnel and 22 activated by EMS pre-hospital (n=52). Data consisted of times from door to: physician, Computer Tomography (CT) scan, CT read, laboratory, stroke team, decision for alteplase, and needle time. Results: The average time from door to physician yielded a decrease by 13 minutes for an EMS alert compared to ED alert. Average door to CT scan time were decreased by 6 minutes using the EMS alert. Average times from door to laboratory completion decreased by 5 minutes using the EMS alert. Average time for door to stroke team was decreased by 9 minutes using the EMS alert. Door to needle times did not differ between groups, but the percentage of patients receiving alteplase increased in the EMS alert group (18.2% with EMS alert compared to 3.3% with an ED alert). Conclusion: In conclusion, the findings of this study suggest times for assessment are improved through EMS pre-notification and early initiation of the hospital stroke-alert system. It also shows an increase in the use of alteplase when there is pre-hospital notification of a potential stroke patient.