The Impact of Ambulance Practice on Acute Stroke Care

Abstract

Background and Purpose-Few patients with acute stroke are treated with alteplase, often due to significant prehospital delays after symptom onset. The aims of this study were to: (1) identify factors associated with rapid first medical assessment in the emergency department after a call for ambulance assistance, and (2) determine the impact of ambulance practice on times from the ambulance call to first medical assessment in the emergency department. Methods-During a 6-month period in 2004, all ambulance-transported patients with stroke or transient ischemic attack arriving from a geographically defined region in Melbourne, Australia (population 383 000) to one of 3 hospital emergency departments were assessed prospectively. Ambulance records including the tape recording of the call for ambulance assistance and hospital medical records, were analyzed. Results-One hundred ninety-eight patients were included in the study. One hundred eighty-seven ambulance patient care records were complete and available for analysis. Factors associated with first medical assessment in the emergency department Ͻ60 minutes from the ambulance call and Ͻ10 minutes from hospital arrival were: Glasgow Coma Scale Ͻ13 (PϽ0.001 and Pϭ0.021) and hospital prenotification (Pϭ0.04 and PϽ0.001). Paramedic stroke recognition and hospital prenotification were associated with shorter times from the ambulance call to first medical assessment (Pϭ0.001 and PϽ0.001). Conclusions-Paramedic stroke recognition and hospital prenotification are associated with shorter prehospital times from the ambulance call to hospital arrival and in-hospital times from hospital arrival to first medical assessment. This highlights the importance of including ambulance practice in comprehensive care pathways that span the whole process of stroke care.

Diagnostic Accuracy of Plasma Glial Fibrillary Acidic Protein for Differentiating Intracerebral Hemorrhage and Cerebral Ischemia in Patients with Symptoms of Acute Stroke

“…On the other hand, it is important to mention that-because of the slightly reduced diagnostic sensitivity-a GFAP blood test will not function as a sufficient measure to rule out ICH in patients with ischemic stroke who otherwise qualify for receiving thrombolytic therapy. Rather, GFAP will allow an optimized triage to specialized stroke centers, which is likely to reduce the time interval to thrombolytic therapy (6 ).…”

“…For example, the prenotification of the hospital of the impending arrival of a patient with acute stroke symptoms increases the frequency of thrombolysis and shortens the time until initiation of treatment (6 ). Thus, having a near-patient test device able to reliably differentiate between ischemic stroke and ICH in the preclinical setting would be desirable.…”

Acil Servise Başvuran Akut İskemik İnmeli 124 Hastanın Geriye Yönelik Bir Yıllık İncelenmesi

“…(22) yaptıkları çalışmada da hastane öncesi dönemde gecikmeye neden olan en önemli sürecin, medikal yardım isteme süresindeki uzunluk olduğunu bulmuşlardır. İnme semptom başlangıcından ambulans çağrılmasına kadar geçen süre, hastane öncesi gecikmenin en büyük kısmını oluşturmaktadır (38)(39)(40)(41) . Medikal talebin gecikmesindeki önemli etkenler inme semptomlarının bilinmemesi, ciddiyetinin farkına varılmaması, bunun yanı sıra hastalığın görmezden gelinmesi ve semptomların kendiliğinden düzeleceği beklentisidir (25) .…”

Emergency Stroke Calls: Obtaining Rapid Telephone Triage (ESCORTT) – a programme of research to facilitate recognition of stroke by emergency medical dispatchers

“…Pre-hospital notification of a patient with suspected stroke is known to be strongly associated with rapid admission to hospital, 42 and is perhaps especially important in expediting assessment and delivery of thrombolytic therapy for eligible patients. It is possible that this opportunity is missed when non-stroke categories are used by EMDs.…”