Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-25T06:57:05.227Z Has data issue: false hasContentIssue false
  • English
  • Français

Can Emergency Medical Services (EMS) Shorten the Time to Stroke Team Activation, Computed Tomography (CT), and the Time to Receiving Antithrombotic Therapy? A Prospective Cohort Study

Published online by Cambridge University Press:  14 February 2020

Abdullah Alabdali Open the ORCID record for Abdullah Alabdali [Opens in a new window] ,
Sami Yousif ,
Abdullah Alsaleem ,
Mazen Aldhubayb  and
Nawfal Aljerian
Abdullah Alabdali*
Affiliation:
Emergency Medical Services Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
Sami Yousif
Affiliation:
Emergency Medical Services Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
Abdullah Alsaleem
Affiliation:
Emergency Medical Services Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
Mazen Aldhubayb
Affiliation:
Emergency Medical Services Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
Nawfal Aljerian
Affiliation:
Emergency Medical Services Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia Medical Referrals Department, Ministry of Health, Riyadh, Saudi Arabia
*
Correspondence: Abdullah Alabdali, PhD, Assistant Professor and EMS Program Director, Emergency Medical Services Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia, E-mail: abdalia@ksau-hs.edu.sa
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Stroke is a major emergency that can cause a significant morbidity and mortality. Advancement in stroke management in recent years has allowed more patients to be diagnosed and treated by stroke teams; however, stroke is a time-sensitive emergency that requires a high level of coordination, particularly within the prehospital phase. This research is to determine whether patients received by Emergency Medical Services (EMS) at a tertiary health care facility had shorter stroke team activation, time to computed tomography (CT), or time to receive intravenous thrombolytics.

Methods:

This research is a prospective cohort study of adults with stroke symptoms who required stroke team activation at a tertiary medical facility. The study included all patients received from September 1, 2017 through August 31, 2018. The primary outcome was the time difference to stroke team activation between patients received by EMS compared to patients that arrived by a private method of transportation. The secondary outcomes were the difference in time to CT scan and the time to receive intravenous recombinant tissue plasminogen activator (rtPA).

Results:

There were 75 (34.1%) patients who had been received by EMS, while 145 (65.9%) patients arrived via private transportation method (private car or by a friend/family member). The mean time to stroke team activation, time to CT, and time to receive thrombolytic therapy for the EMS group were: 8.19 (95% CI, 6.97 - 9.41) minutes; 18 (95% CI, 15.9 - 20.1) minutes; and 13.1 (95% CI, 6.95 - 19.3) minutes, respectively. Those for the private car group, on the other hand, were: 16 (95% CI, 12.4 - 19.6) minutes; 23.39 (95% CI, 19.6 - 27.2) minutes; and nine (95% CI, 4.54 -13.5) minutes, respectively. There was a significantly shorter time to stroke team activation for patients arriving via EMS compared to private car (P ≤ .00), but no significant difference was found on time to CT (P = .259) or time to receive rtPA (P = .100).

Conclusion:

Emergency Medical Service transportation of stroke patients can significantly shorten the time to stroke team activation, leading to shorter triage and accelerated patient management. However, there was no statistical difference in time to CT or time to receive rtPA. Patients with stroke symptoms may benefit more from EMS transportation compared to private methods of transportation.

Keywords

allied health personnelambulancespatient safetypatient transferstroketransportation of patients
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 35 , Issue 2 , April 2020 , pp. 148 - 151
Copyright
© World Association for Disaster and Emergency Medicine 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Feigin, VL, Krishnamurthi, RV, Parmar, P, et al. Update on the global burden of ischemic and hemorrhagic stroke in 1990–2013: the GBD 2013 Study. Neuroepidemiology. 2015;45(3):161–176.CrossRefGoogle ScholarPubMed
National Stroke Association. What is stroke? https://www.stroke.org/understand-stroke/what-is-stroke/. Accessed April 29, 2019.Google Scholar
Centers for Disease Control and Prevention. Types of Stroke. https://www.cdc.gov/stroke/types_of_stroke.htm. Accessed March 23, 2019.Google Scholar
Mayo Clinic. Stroke – symptoms and causes. https://www.mayoclinic.org/diseases-conditions/stroke/symptoms-causes/syc-20350113. Accessed March 23, 2019.Google Scholar
National Cancer Institute. NCI Dictionary of Cancer Terms. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/recombinant-tissue-plasminogen-activator. Accessed March 29, 2019.Google Scholar
Marler, JR, Tilley, BC, Lu, M, et al. Early stroke treatment associated with better outcome: the NINDS rt-PA stroke study. Neurology. 2000;55(11):1649–1655.CrossRefGoogle ScholarPubMed
Wangqin, R, Laskowitz, DT, Wang, Y, et al. International comparison of patient characteristics and quality of care for ischemic stroke: analysis of the China National Stroke Registry and the American Heart Association Get with The Guidelines-Stroke Program. J Am Heart Assoc. 2018;7(20):e010623.10.1161/JAHA.118.010623CrossRefGoogle ScholarPubMed
Al Khathaami, AM, Mohammad, YO, Alibrahim, FS, Jradi, HA. Factors associated with late arrival of acute stroke patients to emergency department in Saudi Arabia. SAGE Open Med. 2018;6:2050312118776719.CrossRefGoogle ScholarPubMed
Tran, J, Mirzaei, M, Anderson, L, Leeder, SR. The epidemiology of stroke in the Middle East and North Africa. J Neurol Sci. 2010;295(1–2):38–40.CrossRefGoogle ScholarPubMed
Kothari, R, Jauch, E, Broderick, J, et al. Acute stroke: delays to presentation and emergency department evaluation. Ann Emerg Med. 1999;33(1):3–8.10.1016/S0196-0644(99)70431-2CrossRefGoogle ScholarPubMed
Yu, RF, San Jose, MC, Manzanilla, BM, Oris, MY, Gan, R. Sources and reasons for delays in the care of acute stroke patients. J Neurol Sci. 2002;199(1–2):49–54.CrossRefGoogle ScholarPubMed