Impact of regional pre‐hospital emergency medical services in treatment of patients with acute ischemic stroke

Abstract

Stroke is a major public health concern afflicting an estimated 795,000 Americans annually. The associated morbidity and mortality is staggering. Early treatment with thrombolytics is beneficial. The window for treatment is narrow and minimization of the time from symptom onset to treatment is vital. The general population is not well informed as to the warning signs or symptoms of stroke, leading to substantial delays in emergency medical services (EMS) activation. Ambulance transport of stroke patients to the hospital has demonstrated improvements in key benchmarks such as door to physician evaluation, door to CT initiation, and increased thrombolytic treatment. Pre-hospital notification of the impending arrival of a stroke patient allows for vital preparation in the treating emergency department, and improving timely evaluation and treatment upon arrival of the stroke patient. EMS systems are a vital component of the management of stroke patients, and resources used to improve these systems are beneficial.

Impact of prehospital stroke code in a public center in Paraguay: A pilot study

“…Our results are concordant with other published experience. 1,7,16,17 However, the rate of PSC in our series was only 27.9% of overall stroke codes; much higher rates have been observed in others studies. 8,18 The relatively recent implementation of the PSC process and general lack of knowledge about stroke awareness are possible reasons to explain this finding and should be explored.…”

Emergency Medical Services Utilization in EMS Priority Conditions in Beirut, Lebanon

“…Early activation or use of Emergency Medical Services (EMS) are associated with improved outcomes in patients with EMS priority conditions. 1,2 The EMS outcome project, a cooperative project funded by the US National Highway Traffic Safety Administration (Washington, DC USA), defined these conditions as important in EMS research because of either their relatively high frequencies or because of the impact of early treatment provided by EMS. 3 For adult patients, the top quartile EMS conditions accounted for 65.5% of all emergency transports in a US study population and included minor trauma, respiratory distress, chest pain, major trauma, cardiac arrest, airway obstruction, and respiratory arrest.…”

“…3 More specifically, activation or use of EMS in time-sensitive conditions such as cardiac arrest, stroke, or myocardial infarction are associated with earlier triage, faster access to treatment, and improved patient outcome. 1,2,[4][5][6] The evidence for the clinical effectiveness of prehospital treatment associated with EMS utilization also exists in the form of number needed to treat for various conditions. 7 Lebanon has a relatively under-developed EMS system that is fragmented with multiple volunteer agencies operating at the Basic Life Support level.…”

Need to Prioritize Education of the Public Regarding Stroke Symptoms and Faster Activation of the 9-1-1 System: Findings from the Florida–Puerto Rico CReSD Stroke Registry

“…Patients arriving by EMS generally achieve SHA faster and they receive CT imaging, intravenous tissue plasminogen activator (tPA) therapy and endovascular rescue treatment sooner. 16,17 Stroke mortality and disability outcomes are highly-influenced by the timespan from stroke symptom onset to treatment. 15,18 Therefore, even in this presumably best-case scenario of EMS-managed response, the delays identified should be considered even more concerning.…”