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Tytuł:
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A novel emergency medical services protocol to improve treatment time for large vessel occlusion strokes.
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Autorzy:
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Glober N; Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America.
Supples M; Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America.
Persaud S; Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America.
Kim D; Department of Emergency Medicine, Stanford University, Santa Clara County, California, United States of America.
Liao M; Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America.
Glidden M; Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America.
O'Donnell D; Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America.
Tainter C; Department of Anesthesiology Critical Care, University of California at San Diego, San Diego, California, United States of America.
Boustani M; Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America.
Alexander A; Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America.
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Źródło:
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PloS one [PLoS One] 2022 Feb 25; Vol. 17 (2), pp. e0264539. Date of Electronic Publication: 2022 Feb 25 (Print Publication: 2022).
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Typ publikacji:
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Journal Article; Research Support, U.S. Gov't, P.H.S.
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Język:
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English
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Imprint Name(s):
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Original Publication: San Francisco, CA : Public Library of Science
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MeSH Terms:
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Clinical Protocols*
Emergency Medical Services*/methods
Time-to-Treatment*
Stroke/*therapy
Aged ; Arterial Occlusive Diseases/therapy ; Computed Tomography Angiography ; Female ; Humans ; Ischemic Stroke/therapy ; Male ; Middle Aged ; Neurologists/psychology ; Patient Transfer ; Physicians/psychology ; Pilot Projects ; Surveys and Questionnaires
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References:
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Grant Information:
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K12 HS026390 United States HS AHRQ HHS
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Entry Date(s):
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Date Created: 20220225 Date Completed: 20220314 Latest Revision: 20220314
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Update Code:
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20240105
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PubMed Central ID:
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PMC8880856
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DOI:
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10.1371/journal.pone.0264539
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PMID:
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35213646
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In many systems, patients with large vessel occlusion (LVO) strokes experience delays in transport to thrombectomy-capable centers. This pilot study examined use of a novel emergency medical services (EMS) protocol to expedite transfer of patients with LVOs to a comprehensive stroke center (CSC). From October 1, 2020 to February 22, 2021, Indianapolis EMS piloted a protocol, in which paramedics, after transporting a patient with a possible stroke remained at the patient's bedside until released by the emergency department or neurology physician. In patients with possible LVO, EMS providers remained at the bedside until the clinical assessment and CT angiography (CTA) were complete. If indicated, the paramedics at bedside transferred the patient, via the same ambulance, to a nearby thrombectomy-capable CSC with which an automatic transfer agreement had been arranged. This five-month mixed methods study included case-control assessment of use of the protocol, number of transfers, safety during transport, and time saved in transfer compared to emergent transfers via conventional interfacility transfer agencies. In qualitative analysis EMS providers, and ED physicians and neurologists at both sending and receiving institutions, completed e-mail surveys on the process, and offered suggestions for process improvement. Responses were coded with an inductive content analysis approach. The protocol was used 42 times during the study period; four patients were found to have LVOs and were transferred to the CSC. There were no adverse events. Median time from decision-to-transfer to arrival at the CSC was 27.5 minutes (IQR 24.5-29.0), compared to 314.5 minutes (IQR 204.0-459.3) for acute non-stroke transfers during the same period. Major themes of provider impressions included: incomplete awareness of the protocol, smooth process, challenges when a stroke alert was activated after EMS left the hospital, greater involvement of EMS in patient care, and comments on communication and efficiency. This pilot study demonstrated the feasibility, safety, and efficiency of a novel approach to expedite endovascular therapy for patients with LVOs.
Competing Interests: The authors have declared that no competing interests exist.
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