Less is more - The Finnish Prehospital Stroke Scale prospective validation

Ollikainen, Jyrki; Jolma, Pasi; Pienimäki, Juha-Pekka; Vuorinen, Pauli; Oksala, Niku; Kimpimäki, Marko; Grönroos, Markku; Haula, Tuuli‐Maria; Janhunen, Heikki; Pauniaho, Satu‐Liisa

doi:10.1016/j.jstrokecerebrovasdis.2023.106996

Cited by 4 publications

(2 citation statements)

References 28 publications

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“…The paramedics in a predefined region consulted the on-call neurologist at the Tampere university hospital when the patient had symptoms highly indicative of an LVO. Suspected stroke patients were screened with the Finnish Prehospital Stroke Scale and the directly to CSC -strategy was chosen when applicable [ 16 ]. More specifically, LVO was suspected if the patient presented with hemiparesis and conjugate eye deviation away from the side of the hemiparesis.…”

Section: Methodsmentioning

confidence: 99%

Optimizing remote and rural prehospital resources using air transport of thrombectomy candidates

Vuorinen,

Setälä,

Hoppu

2024

Scand J Trauma Resusc Emerg Med

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Background In Finland, the yearly number of mechanical thrombectomies for acute stroke is increasing and more patients are transported over 100 km to the comprehensive stroke centre (CSC) for definitive care. This leaves the rural townships without immediate emergency medical services (EMS) for hours. In this study we compare the EMS’ estimated return times to own station after the handover of a thrombectomy candidate between two transport methods: (1) using ground transportation with an ambulance to the CSC or (2) using a hydrid strategy starting the transportation with an ambulance and continuing by air with a helicopter emergency medical services unit (HEMS). Methods We reviewed retrospectively all thrombectomy candidates’ transportations from the hospital district of South Ostrobothnia to definitive care at the nearest CSC, Tampere University Hospital from June 2020 to October 2022. The dispatch protocol stated that a thrombectomy candidate’s transport begins immediately with an ambulance and if the local HEMS unit is available the patient is handed over to them at a rendezvous. If not, the patient is transported to the CSC by ground. Transport times and locations of the patient handovers were reviewed from the CSC’s EMS database and the driving time back to ambulance station was estimated using Google maps. The HEMS unit’s pilot’s log was reviewed to assess their mission engagement time. Results The median distance from the CSC to the ambulances’ stations was 188 km (IQR 149–204 km) and from the rendezvous with the HEMS unit 70 km (IQR 51–91 km, p < 0.001). The estimated median driving time back to station after the patient handover at the CSC was 145 min (IQR 117–153 min) compared to the patient handover to the HEMS unit 53 min (IQR 38–68 min, p < 0.001). The HEMS unit was occupied in thrombectomy candidate’s transport mission for a median of 136 min (IQR 127–148 min). Conclusion A hybrid strategy to transport thrombectomy candidates with an ambulance and a helicopter reallocates the EMS resources markedly faster back to their own district.

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Section: Methodsmentioning

confidence: 99%

Optimizing remote and rural prehospital resources using air transport of thrombectomy candidates

Vuorinen,

Setälä,

Hoppu

2024

Scand J Trauma Resusc Emerg Med

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“…Previously, nurse paramedics were taught to recognize stroke patients by using the face-arm-speech triad, but with the evolution of interventional radiology in the treatment of large vessel occlusions (LVOs), intensive training was implemented for paramedics. Since 2017, they have screened patients as candidates for thrombolytic therapy and mechanical thrombectomy by using the Finnish Prehospital Stroke Scale [ 8 ].…”

Section: Methodsmentioning

confidence: 99%

Impact of the first response unit on prehospital on-scene time among paramedic-suspected stroke patients: a retrospective before–after cohort study in Finland

Vaajanen

Vuorinen

Setälä

et al. 2023

Scand J Trauma Resusc Emerg Med

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Background Revascularization of an occluded artery by either thrombolysis or mechanical thrombectomy is a time-critical intervention in ischaemic stroke. Each link in the stroke chain of survival should minimize the delay to definitive treatment in every possible way. In this study, we investigated the effect of routine dispatch of a first response unit (FRU) on prehospital on-scene time (OST) on stroke missions. Methods Medical dispatch of FRU together with an emergency medical service (EMS) ambulance was a routine strategy in the Tampere University Hospital area before 3 October 2018, after which the FRU has only been dispatched to medical emergencies on the decision of an EMS field commander. This study presents a retrospective before–after analysis of 2,228 paramedic-suspected strokes transported by EMSs to Tampere University Hospital. We collected data from EMS medical records from April 2016 to March 2021, and used statistical tests and binary logistic regression to detect the associations between the variables and the shorter and longer half of OSTs. Results The median OST of stroke missions was 19 min, IQR [14–25] min. The OST decreased when the routine use of the FRU was discontinued (19 [14–26] min vs. 18 [13–24] min, p < 0.001). The median OST with the FRU being the first at the scene (n = 256, 11%) was shorter than in cases where the FRU arrived after the ambulance (16 [12–22] min vs. 19 [15–25] min, p < 0.001). The OST with a stroke dispatch code was shorter than with non-stroke dispatches (18 [13–23] min vs. 22 [15–30] min, p < 0.001). The OST for thrombectomy candidates was shorter than that for thrombolysis candidates (18 [13–23] min vs. 19 [14–25], p = 0.01). The shorter half of OSTs were associated with the FRU arriving first at the scene, stroke dispatch code, thrombectomy transportation and urban location. Conclusion The routine dispatch of the FRU to stroke missions did not decrease the OST unless the FRU was first to arrive at the scene. In addition, a correct stroke identification in the dispatch centre and thrombectomy candidate status decreased the OST.

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Letter to the editor regarding 'Less is more - the finnish prehospital stroke scale prospective validation'

Rodríguez‐Pardo

2023

Journal of Stroke and Cerebrovascular Diseases

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Less is more - The Finnish Prehospital Stroke Scale prospective validation

Cited by 4 publications

References 28 publications

Optimizing remote and rural prehospital resources using air transport of thrombectomy candidates

Optimizing remote and rural prehospital resources using air transport of thrombectomy candidates

Impact of the first response unit on prehospital on-scene time among paramedic-suspected stroke patients: a retrospective before–after cohort study in Finland

Letter to the editor regarding 'Less is more - the finnish prehospital stroke scale prospective validation'

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