Abstract TMP67: Pre-Hospital FAST-ED Initiatives Improve t-PA and Endovascular Treatment Times

Abstract

Introduction: Acute stroke outcomes largely depend on timely reperfusion treatment. On March 2017 Miami Dade County EMS (MDFR) implemented a pre-hospital FAST-ED scale initiative. Those with a score ≥ 4 bypass other centers for a comprehensive stroke center (CSC) and those with a score ≥ 6 also have the neuro interventional team activated from the field. We sought to analyze the impact of this initiative on treatment times. Methods: All stroke cases brought to Baptist Hospital of Miami by MDFR during the months of March, April, and May 2017 were included. Treatment times were compared on vs. off hours and to those with a FAST-ED score ≥6. We compared our data to the immediately preceding 3 months and to the same months 1 year ago. We used the FAST-ED score documented on the run sheet. Results: During the first 3 months of the initiative 139 patients were received at our CSC from MDFR. Of these, 84 (60%) were coded as stroke (ischemic, hemorrhagic, or TIA), and 23 (17%) underwent reperfusion treatments. Age, gender, and pre-treatment NIHSS were comparable across time periods. Treatment times are described on Table 1. The initiative led to overall faster door to groin times by 23 min compared to the previous 3 months (n.s.), and 33 min (33%) compared to the previous year (p=0.02). During off hours for FAST-ED ≥ 6, there was a 46 min (43%) improvement from the previous 3 months (p=0.05) and a 69 min (52%) improvement from the previous year (p=0.01). Door to needle time improved only for off hours cases with FAST-ED ≥ 6. Times improved by 10 min (27%) compared to the previous 3 months (p=0.03) and 16 min (37%) compared to the year prior (p=0.01). Discussion: The Miami Dade County FAST-ED scale initiative leads to clinical, and statistical, significant faster treatment times for both IV tPA and endovascular treatments. The highest impact is for off-hours and those with a score ≥ 6.