Abstract WP282: Use of Emergent Ambulance Transport With Lights and Siren Leads to Significant Time Savings for Inter-Facility Transfers of Patients With Large Vessel Occlusion

Abstract

Introduction: When emergency medical services (EMS) responds to a field call for a patient experiencing stroke symptoms, the response is emergent, necessitating the use of lights and siren (L&S) to allow for expedited transport to a stroke-capable center. With the expanded use of endovascular therapy (EVT) for large-vessel occlusion (LVO), many stroke-capable centers are transferring larger numbers of LVO patients to EVT-capable centers for definitive care. Interestingly, many EMS systems do not respond to or transport inter-facility transfers emergently with L&S. This can potentially lead to delays in care and worse clinical outcomes. Given increased scrutiny surrounding the safety and utility of L&S transport among EMS providers, we investigated the difference between emergent and non-emergent transfer of confirmed LVO stroke patients from two institutions with varied distances and traffic patterns. Methods: A retrospective analysis was performed of 127 consecutive inter-facility transfers for LVO from two facilities, Hospital A (38.5 miles) and Hospital B (5.5 miles), to the University of Michigan Comprehensive Stroke Center over 3 years and 2 years respectively. Transfers by helicopter (17/127; 13.4%) and those without available EMS data (9/127; 7.1%) were excluded. Final review included 50 cases from Hospital A and 51 from Hospital B. Run times and use of L&S during transport were collected. A t-test was used to examine whether the observed differences in transport times were statistically significant. Results: Of the 50 transfers from Hospital A, 22 were transported without L&S use and 28 with L&S. The mean transport time was 44 minutes versus 35 minutes, respectively. From Hospital B, there were 14 transfers transported without L&S use and 37 with L&S. The mean transport time was 15 minutes versus 9 minutes, respectively. For both samples, p-value was <0.01. Conclusion: Despite a small sample size, this analysis demonstrates significant time savings using L&S during inter-facility transfer of stroke patients with confirmed LVO. While inherent risk is associated with the use of L&S during EMS transport, judicious use for confirmed time-sensitive indications seems warranted.