Cutting the Prehospital On-Scene Time of Stroke Thrombolysis in Helsinki: A Prospective Interventional Study. Issue 12 (December 2016)

• Record Type: Journal Article
• Authors: Puolakka, Tuukka; Kuisma, Markku; Länkimäki, Sami; Puolakka, Jyrki; Hallikainen, Juhana; Rantanen, Kirsi; Lindsberg, Perttu J.
• Is Part Of: Stroke. Volume 47:Issue 12(2016)
• Publication Date: 2016-12
• Subjects: ambulance -- attention -- emergency medical services -- expedition -- stroke; Cerebrovascular disease -- Periodicals; Cerebral circulation -- Periodicals; 616.81
• DOI: 10.1161/STROKEAHA.116.014531
• Languages: English
• ISSNs: 0039-2499

Abstract

Abstract : Background and Purpose—: Significant portion of the prehospital delay consists of minutes spent on the scene with the patient. We implemented a training program for the emergency medical services personnel with the aim to optimize the on-scene time (OST) and to study the impact of different elements of prehospital practice to the OST duration. Methods—: In this prospective interventional study, key operational emergency medical service performance variables were analyzed from all thrombolysis candidates transported to the Helsinki University Hospital emergency department. The catchment period was 4 months before and 4 months after the implementation. Results—: One hundred and forty-one patients were managed as thrombolysis candidates before and 148 patients after the training program implementation. The OST duration for the groups was 25 (20.5–31) and 22.5 (18–28.5) minutes, respectively ( P <0.001). Physician consultations via telephone were associated with a longer (odds ratio 0.546 [0.333–0.893]) and advanced life support training with a shorter OST (odds ration 1.760 [1.070–2.895]). Conclusions—: Implementation of the emergency medical services training program successfully decreased the OST of thrombolysis candidates by 10%. Higher expertise level of the ambulance crew was associated with shorter OST, and decisions to consult a physician via telephone were reflected by longer OST. Abstract : Supplemental Digital Content is available in the text.