Abstract TP382: Multidisciplinary Collaboration Yields Emergency Medical Services (EMS) Inter-Facility Transfer Document to Ensure Patient Safety

Abstract

In the current era of advancing stroke care, rapid evaluation and treatment of an acute ischemic stroke should be standard practice based on current evidence and guidelines. Acute stroke treatment with intravenous (IV) thrombolytic should be started at the presenting facility when indicated. After this initial treatment, patients may then be transferred to the next higher level of care via a qualified EMS provider agency. These transfers are completed by either air or ground ambulance services. Patient safety during transport, especially for those receiving IV thrombolytic, must be ensured while minimizing door-in/door out times. The Stroke Consortium of Indiana (SCI), represents 48 Indiana hospitals and other organizations within the state, prioritized implementation of a stroke interfacility guideline to standardize medical care provided during the transfer process. The State EMS Medical Director joined our consortium to represent the EMS system. A search of existing literature and protocols, as well as inter-state discussions, led to the determination that further development of guidelines currently utilized within the region was needed. Indiana, like many other Midwestern states, has areas that are underserved by EMS with varying protocols written by a local EMS medical director. There are 833 different EMS provider agencies in Indiana each operating under different local protocols. EMS conducted 658 interfacility transfers for acute stroke treatment in 2018. There are currently 5 comprehensive, 35 primary, and 5 stroke ready centers certified of 118 total hospitals in the state. During the development of this document, the members of SCI were provided multiple opportunities to give feedback and discussion. The document was finalized, adopted, and is available online at the IDHS website at https://www.in.gov/dhs/3781.htm. The goal of this best practice document is to provide guidance and support for adoption at the local EMS provider agency level and support EMS collaboration with local stroke centers in communities across Indiana. SCI members are encouraged to socialize and implement this guideline at the local level in cooperation with their local EMS agencies.