Abstract WP84: The 'When' in Response to BEFAST by EMS

Abstract

Background: In cases of suspected stroke in prehospital patients, EMS response focuses on rapid assessment and transport. In Arkansas, stroke patients are identified by a unique barcode wristband for tracking and quality assurance. Prehospital stroke screens, such as BEFAST (Balance, Eyes, Face, Speech and Time), may influence destination decisions and transport time. We examined utilization of Stroke as a primary impression, compliance with placing stroke bands, if prehospital BEFAST influenced transport times from First Medical Contact (FMC), and which components were associated with rapid transport. Methods: In a single large urban EMS agency, prehospital care records of suspected stroke from Jan 1 to Dec 31, 2022, were retrospectively evaluated utilizing primary or secondary impression of Stroke or Transient Ischemic Attack (TIA). FMC and BEFAST performance time was noted and time intervals of FMC to BEFAST (FMC2BEFAST) and FMC to Arrival at destination (FMC2Arrival). Protocol compliance was determined by the placement of a stroke band. Time measures and BEFAST normal or abnormal scores were determined by ANOVA and protocol compliance with BEFAST with chi-square analysis. Results: There were 224 EMS transports for Stroke/TIA in 2022. Stroke bands were placed in 54% of patients with Stroke/TIA impressions. Stroke was a primary impression in 13% of transports and a secondary impression in 77% of transports. Patients with abnormal BEFAS(T) were 54, 26, 36, 41 and 60%, respectively. Stroke bands were placed in 61, 65, 69, 27 and 62%, respectively of cases with an abnormal BEFAS(T) (p < 0.018). FMC2Arrival time had a 9 min improvement with stroke band placement (p=0.0021). Patients with abnormal Facial Droop (p=0.043) and Eye Disturbance (p=0.022) had significantly shorter FMC2Arrival times. Abnormal Balance, Arm Drift nor Speech was not associated with shorter FMC2Arrival times (p=NS). Conclusions: Rapid evaluation and transport of suspected stroke patients can be challenging. Identification was low in our single center study, abnormalities in Facial Droop and Eye Disturbances resulted in faster transport time. Improved training on the identification and screening may result in a higher stroke band placement, recognition and rapid transport times.