Ian G Stiell1, Catherine M Clement2, Kristy Campbell2, Mukul Sharma2, Doug Socha2, Marco L A Sivilotti2, Albert Jin2, Jeffrey J Perry2, Jim Lumsden2, Cally Martin2, Mark Froats2, Richard Dionne2, John Trickett2. 1. From the Department of Emergency Medicine (I.G.S., J.J.P., R.D.) and Clinical Epidemiology Program, Ottawa Hospital Research Institute (I.G.S., C.M.C., J.J.P., J.T.), University of Ottawa, The Ottawa Hospital, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada (M.S.); Hastings-Quinte Paramedic Services, Belleville, Ontario, Canada (D.S.); Department of Emergency Medicine (M.L.A.S., M.F.) and Department of Medicine (A.J.), Queen's University, Kingston, Ontario, Canada; Regional Paramedic Program for Eastern Ontario, Ottawa, Canada (K.C., R.D.); Champlain Regional Stroke Network, Ottawa, Ontario, Canada (J.L.); and Stroke Network of Southeastern Ontario, Kingston General Hospital, Canada (C.M.). istiell@ohri.ca. 2. From the Department of Emergency Medicine (I.G.S., J.J.P., R.D.) and Clinical Epidemiology Program, Ottawa Hospital Research Institute (I.G.S., C.M.C., J.J.P., J.T.), University of Ottawa, The Ottawa Hospital, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada (M.S.); Hastings-Quinte Paramedic Services, Belleville, Ontario, Canada (D.S.); Department of Emergency Medicine (M.L.A.S., M.F.) and Department of Medicine (A.J.), Queen's University, Kingston, Ontario, Canada; Regional Paramedic Program for Eastern Ontario, Ottawa, Canada (K.C., R.D.); Champlain Regional Stroke Network, Ottawa, Ontario, Canada (J.L.); and Stroke Network of Southeastern Ontario, Kingston General Hospital, Canada (C.M.).
Abstract
BACKGROUND AND PURPOSE: The Ontario Acute Stroke Medical Redirect Paramedic Protocol (ASMRPP) was revised to allow paramedics to bypass to designated stroke centers if total transport time would be <2 hours and total time from symptom onset <3.5 hours. We sought to evaluate the impact and safety of implementing the Revised ASMRPP. METHODS: We conducted a 12-month implementation study involving prehospital patients presenting with possible stroke symptoms. A total of 1317 basic and advanced life support paramedics, of 9 land services in 10 rural counties and 5 cities, used the Revised ASMRPP to take appropriate patients directly to 6 designated stroke centers. RESULTS: We enrolled 1277 patients with 98.8% paramedic compliance in form completion. Of these, 755 (61.2%) met the redirect criteria and had these characteristics: mean age 72.1 (range 16-101), male 51.1%, mean time scene to hospital 16.7 minutes (range 0-92). Paramedics demonstrated excellent interobserver agreement (κ, 0.94; 95% confidence interval, 0.91-0.96) and 97.9% accuracy in interpretation of the Revised ASMRPP. Prehospital adverse events occurred in 14.7% of patients, but few were life-threatening. Overall, 71.4% of 755 cases had a stroke code activated at the hospital and 23.2% received thrombolysis. For the 189 potential stroke patients picked up in 1 city, the ASMRPP classified thrombolysis administration with sensitivity 100% and specificity 37.3% and a final diagnosis of stroke, with sensitivity 86.1% and specificity 41.9%. CONCLUSIONS: In a large urban-rural area with 9 paramedic services, we demonstrated accurate, safe, and effective implementation of the Revised ASMRPP. These revisions will allow more patients with stroke to benefit from early treatment.
BACKGROUND AND PURPOSE: The Ontario Acute Stroke Medical Redirect Paramedic Protocol (ASMRPP) was revised to allow paramedics to bypass to designated stroke centers if total transport time would be <2 hours and total time from symptom onset <3.5 hours. We sought to evaluate the impact and safety of implementing the Revised ASMRPP. METHODS: We conducted a 12-month implementation study involving prehospital patients presenting with possible stroke symptoms. A total of 1317 basic and advanced life support paramedics, of 9 land services in 10 rural counties and 5 cities, used the Revised ASMRPP to take appropriate patients directly to 6 designated stroke centers. RESULTS: We enrolled 1277 patients with 98.8% paramedic compliance in form completion. Of these, 755 (61.2%) met the redirect criteria and had these characteristics: mean age 72.1 (range 16-101), male 51.1%, mean time scene to hospital 16.7 minutes (range 0-92). Paramedics demonstrated excellent interobserver agreement (κ, 0.94; 95% confidence interval, 0.91-0.96) and 97.9% accuracy in interpretation of the Revised ASMRPP. Prehospital adverse events occurred in 14.7% of patients, but few were life-threatening. Overall, 71.4% of 755 cases had a stroke code activated at the hospital and 23.2% received thrombolysis. For the 189 potential strokepatients picked up in 1 city, the ASMRPP classified thrombolysis administration with sensitivity 100% and specificity 37.3% and a final diagnosis of stroke, with sensitivity 86.1% and specificity 41.9%. CONCLUSIONS: In a large urban-rural area with 9 paramedic services, we demonstrated accurate, safe, and effective implementation of the Revised ASMRPP. These revisions will allow more patients with stroke to benefit from early treatment.
Authors: Christopher T Richards; Ryan Huebinger; Katie L Tataris; Joseph M Weber; Laura Eggers; Eddie Markul; Leslee Stein-Spencer; Kenneth S Pearlman; Jane L Holl; Shyam Prabhakaran Journal: Prehosp Emerg Care Date: 2018-01-03 Impact factor: 3.077