In the thrombectomy era, triage in the field improves care

Fifi, Johanna T; Dabus, Guilherme; Mack, William J.; Mocco, J; Pride, Lee; Arthur, Adam S; Albuquerque, Felipe C

doi:10.1136/neurintsurg-2018-014136

Cited by 4 publications

(2 citation statements)

References 21 publications

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“…This is largely influenced by prehospital and in-hospital processes. 2 Most current prehospital operational algorithms for suspected stroke require that emergency medical services (EMS) take patients to the nearest hospital. Components of this current system must, in various ways, evolve.…”

Section: Introductionmentioning

confidence: 99%

Technological innovation for prehospital stroke triage: ripe for disruption

Martínez-Gutiérrez

Chandra

Hirsch

et al. 2019

J NeuroIntervent Surg

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BackgroundWith the benefit of mechanical thrombectomy firmly established, the focus has shifted to improved delivery of care. Reducing time from symptom onset to reperfusion is a primary goal. Technology promises tremendous opportunities in the prehospital space to achieve this goal.MethodsThis review explores existing, fledgling, and potential future technologies for application in the prehospital space.ResultsThe opportunity for technology to improve stroke care resides in the detection, evaluation, triage, and transport of patients to an appropriate healthcare facility. Most prehospital technology remains in the early stages of design and implementation.ConclusionThe major challenges to tackle for future improvement in prehospital stroke care are that of public awareness, emergency medical service detection, and triage, and improved systems of stroke care. Thoughtfully applied technology will transform all these areas.

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Section: Introductionmentioning

confidence: 99%

Technological innovation for prehospital stroke triage: ripe for disruption

Martínez-Gutiérrez

Chandra

Hirsch

et al. 2019

J NeuroIntervent Surg

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“…In order to achieve this, early recognition of EVT candidates and referral to hospitals providing EVT is crucial, since interfacility transfers could delay time to reperfusion. It is especially appropriate to perform prehospital triage to send patients with ELVO directly to hospitals providing EVT in urban areas with primary stroke centers and comprehensive stroke centers in close proximity 9. The Society of Neurointerventional Surgery guideline strongly encourages that the emergency medical service (EMS) system should implement a stroke scale for emergency medical technicians (EMTs) to rapidly identify patients with ELVO and perform a bypass strategy if some criteria are met 10 11.…”

Section: Introductionmentioning

confidence: 99%

Using G-FAST to recognize emergent large vessel occlusion: a training program for a prehospital bypass strategy

Chiu

Tang

Sun

et al. 2019

J NeuroIntervent Surg

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IntroductionThe shorter the time between the onset of symptoms and reperfusion using endovascular thrombectomy, the better the functional outcome of patients. A training program was designed for emergency medical technicians (EMTs) to learn the gaze-face-arm-speech-time test (G-FAST) score for initiating a prehospital bypass strategy in an urban city. This study aimed to evaluate the effect of the training program on EMTs.MethodsAll EMTs in the city were invited to join the training program. The program consisted of a 30 min lecture and a 20 min video which demonstrated the G-FAST evaluation. The participants underwent tests before and after the program. The tests included (1) a questionnaire of knowledge, attitudes, confidence, and behaviors towards stroke care; and (2) watching 10 different scenarios in a video and answering questions, including eight sub-questions of G-FAST parameters, and choosing a suitable receiving hospital.ResultsIn total, 1058 EMTs completed the training program. After the program, significant improvement was noted in knowledge, attitudes, and confidence, as well as scenario judgement. The performance of the EMTs in evaluating G-FAST criteria in comatose patients was relatively poor in the pre-test and improved significantly after the training course. Although the participants answered the G-FAST items correctly, they tended to overtriage the patients and refer them to higher-level hospitals.ConclusionsA short training program can improve the ability to identify stroke patients and choose a suitable receiving hospital. A future training program could put further emphasis on how to evaluate comatose patients and choose a suitable receiving hospital.

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