Ahead of Print: The Neurological Emergency Room and Pre-hospital Stroke Alert

Background: Emergency medical services (EMS) pre-notification to hospitals regarding the arrival of stroke patients is recommended to facilitate the work-up once the patient arrives. Most hospitals have the patient enter the emergency room prior to obtaining a head CT. At Capital Health, pre-hospital stroke alert patients are delivered directly to CT and met by a neurological emergency team. The goal of bypassing the emergency room is to reduce the time to treatment.

Objective: To evaluate: 1) door-to-CT and door-to-needle time in acute stroke patients who arrive as pre-hospital stroke alerts and 2) the accuracy of EMS assessment.

Methods: A prospective database of all pre-hospital stroke alert patients was kept and data retrospectively reviewed for patients who were seen between July 2012 and July 2013.

Results: Between July 2012 and July 2013, 141 pre-hospital stroke alerts were called to our emergency department and stable enough to bypass the ED and go directly to CT. EMS assessment of stroke was accurate 66% of the time and the diagnosis was neurological 89% of the time. The average time between patient arrival and acquisition of CT imaging was 11.8 minutes. Twenty-six of the 141 patients (18%) received IV tPA. The median time from arrival to IV tPA bolus was 44 minutes.

Conclusion: Trained EMS are able to correctly identify patients who are suffering from neurological/neurosurgical emergencies and deliver patients to our comprehensive stroke center in a timely fashion after pre-notification. The pre-hospital stroke alert protocol bypasses the ED, allowing the patient to be met in CT by the neurological ED team, which has proven to decrease door-to-CT and door-to-needle times from our historical means.

From: The Neurological Emergency Room and Pre-hospital Stroke Alert: The Whole is Greater Than the Sum of its Parts by Binning et al.

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