Abstract
Introduction: In April, 2014 MEDIC Emergency Medical Services (MEDIC EMS) began activation of call-taker initiated activation of stroke alerts based off of the Stroke Diagnostic Tool on Protocol 28 (Stroke [CVA/Transient Ischemic Attack [TIA])—a tool in the Medical Priority Dispatch System™ (MPDS®) (Version 13, 2016, Priority Dispatch Corp., Salt Lake City, UT, USA). Stroke alerts are sent to the local stroke certified receiving facilities and then to the responding ambulance of the MPDS stroke Determinant Code. Once clear evidence of a stroke (Suffix J) is determined, call takers advise local stroke-certified receiving facilities and the responding ambulance of the Stroke Alert.
Objective: The goal of the study was to assess the stroke alerts process and determine if it significantly reduced the amount of time from ambulance arrival to the patient receiving a tissue plasminogen activator (tPa) treatment.
Methods: Once the determinant code is assigned and the crew is activated, the call-taker contacts the charge nurse at the receiving facility to activate the stroke alert and provides an estimated time of arrival (ETA). Once the ambulance crew arrives on scene and completes their assessment, they confirm or cancel the alert. Causes for cancellation are many and include assessments that a call-taker is not able to see in a nonvisual environment such as a low blood sugar, intoxication, Bell's Palsy, or the symptoms may resolve prior to their arrival.
The emergency department (ED) contacts the neurologist, the laboratory, and if the patient needs imaging, advises computerized tomography (CT). After a brief stop in the emergency room to be evaluated by the ED physician, the EMS crew takes the patient directly to the CT scanner on their ambulance cot.
Data were gathered by regular quality assurance and call auditing processes. Dispatch data was confirmed with EMS-confirmed alerts and hospital results under the direction of neurological quality committees.
Results: When implementing this process in 2014, the hypothesis was that ED notification could be reduced by 18 minutes on average for each call-taker activated stroke alert. By the end of 2017, this hypothesis had been reasonably confirmed with average times saved of 15 minutes and 45 seconds on average in 2015, 16 minutes and 8 seconds on average in 2016, and 14 minutes and 14 seconds on average in 2017. With 1.9 million neurons lost for every minute of delay, the impact is 0.5 cm of
brain tissue damaged per 12 minutes. 2016 yielded 919 billion neurons saved, or 29.77 inches (484 minutes). An NCAA basketball is 29.5 inches in circumference.
Conclusions: As the first, first responders, call-takers used the Stroke Diagnostic Tool as the first stroke assessment and provided their assessment by alert to receiving hospitals and EMS responders. Time was saved, making a difference in receiving facilities meetings their goals of door-to-balloon time and patients experiences better outcomes including reduced mortality and death.