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Abstract Details

Implementation of a rural severity-based EMS stroke destination protocol improves destination selection for EMS suspected strokes.
Cerebrovascular Disease and Interventional Neurology
P9 - Poster Session 9 (11:45 AM-12:45 PM)
13-017
This is an interim analysis of a before-and-after quality improvement study examining the impact of implementation of a severity-based Emergency Medical Services (EMS) stroke destination protocol by three medical control authorities (MCAs). 
EMS routing of stroke patients is challenging in rural settings. American Stroke Association (ASA) has developed a template severity-based EMS triage algorithm to direct EMS to either the nearest stroke-ready versus Comprehensive Stroke Center hospital, but its real-world impact is uncertain. 
As per ASA algorithm, bypass was recommended for patients within 24h of last known well if large vessel occlusion suspected and bypass will not delay thrombolysis. We compared optimal destination selection before and after implementation of the protocol (Chi square tests) and time from EMS scene arrival to thrombolysis or endovascular therapy [EVT] before and after implementation (Wilcoxon Rank Sum tests).

From 11/2021 to 05/2024, EMS transported 616 suspected stroke cases, 272 (44.2%) of which ultimately received a diagnosis of stroke or transient ischemic attack. The protocol was implemented by each MCA in random order at months 21, 23, and 29, resulting in 73 MCA-months before and 17 after implementation. Optimal hospital destinations were selected for 310/499 (62.1%) patients prior to the protocol and 86/117 (73.5%) after (p=0.021). Thrombolytics were administered to 57 patients (48 before; 9 after) and 46 (42 before; 4 after) received EVT. Median times from first EMS contact to needle decreased from 98 (IQR: 79-107) to 77 (IQR: 75-85) minutes (p=0.012); median times from EMS contact to groin puncture increased nonsignificantly from 165 (IQR: 132-216) to 196 (IQR: 191-228) minutes (p=0.110).

Interim analysis of implementation of a rural EMS severity-based triage algorithm for suspected stroke cases resulted in improved destination selection and faster thrombolysis but did not improve EVT treatment times.  This analysis will be repeated once follow-up is completed in 7 months.
Authors/Disclosures
Esam Abobaker, DO (Spectrum Health, Michigan State University)
PRESENTER 		Dr. Abobaker has nothing to disclose.
Malgorzata Miller, MD (Corewell Health) The institution of Dr. Miller has received research support from NIH StrokeNet VERIFY trial.
Brian Wideman, DO Dr. Wideman has nothing to disclose.
Nadeem I. Khan, MD (Spectrum Health) Dr. Khan has nothing to disclose.
Muhib Khan, MD, FAAN (Mayo Clinic) The institution of Dr. Khan has received research support from Mayo Clinic 好色先生 Grant . The institution of Dr. Khan has received research support from Mayo Clinic Small Grants .
Mathew J. Reeves, PhD, BVSc Mathew J. Reeves, PhD, BVSc has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association.
John Oostema, MD Dr. Oostema has received personal compensation for serving as an employee of Life EMS 好色先生 Centre. Dr. Oostema has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Various law firms.