Abstract
Stroke is a major cause of death in Thailand. It requires a specific time period of 4.5 h from onset to treatment to increase recovery rates, and therefore, it can be categorized as a time-sensitive disease. The objective of this research is to identify whether the service areas of the main existing Emergency Medical Services (EMS) prehospital stroke practices cover all areas in Bangkok. This is determined by using GIS mapping. After verifying the current EMS delivery models, comparisons are drawn to find the travelling time of each model. The conditioning factors for GIS mapping were collected and verified, including the traffic speed and duration spent in each mode of the prehospital stroke process. After inputting all of the data into GIS, the service areas were visualized to show the area serviced in each delivery model. The results also show the different hospital groups, including the service areas for (1) non-network hospitals and (2) hospitals with stroke networks. Suggestions for re-networking and adding more hospitals to the existing networks were also identified using GIS. Regularly updating the service area with up-to-date data in GIS is key to improving stroke service areas.
Highlights
According to the World Health Organization (WHO) [1], stroke is one of the top three global causes of death, challenging all governments to act against this rapidly increasing number
The time of arrival at the hospital until recombinant tissue plasminogen activator (rt-PA) administration, referred to as the Door-to-Needle time (DTN), requires 1.5–3.0 h, and patients who are presented to the hospital within the first 60 min of onset time have the greatest opportunity to benefit from recanalization therapy
After adding all data in GIS and comparing each model and time period, the service areas could be portrayed as GIS maps
Summary
According to the World Health Organization (WHO) [1], stroke is one of the top three global causes of death, challenging all governments to act against this rapidly increasing number. Werner Hacke, M.D et al (2008) [3] stated that the “golden hour”—the time that will produce excellent outcomes with significantly lower rates of morbidity and mortality—for stroke, has been adjusted from 3 h to 4.5 h for the time of onset to treatment. In this process, the use of recombinant tissue plasminogen activator (rt-PA) has been the standard of care for stroke treatment for several years. According to Rajiv Advani et al (2017) [4], patients treated within one hour of symptom onset can lead to excellent outcomes without any incidence of iatrogenic bleeds. L. et al, 2010) [5]
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