PMID- 24612593
OWN - NLM
STAT- MEDLINE
DCOM- 20140605
LR  - 20140422
IS  - 1532-8171 (Electronic)
IS  - 0735-6757 (Linking)
VI  - 32
IP  - 5
DP  - 2014 May
TI  - Stroke: prospective evaluation of a prehospital management process based on 
      rescuers under medical direction.
PG  - 438-42
LID - S0735-6757(14)00064-3 [pii]
LID - 10.1016/j.ajem.2014.01.034 [doi]
AB  - BACKGROUND: Improving access to thrombolytic therapy for patients with ischemic 
      stroke is challenging. We assessed a prehospital process based on firemen 
      rescuers under strict medical direction, aimed at facilitating thrombolysis of 
      eligible patients. METHODS: This was a prospective observational study conducted 
      over 4 months in Paris, France. Prehospital patients with suspected stroke were 
      included after telephone consultation with a physician. If the time since the 
      onset of symptoms was less than 6 hours, patients were transported directly to a 
      neurovascular unit (NVU); if symptom onset was more than 6 hours ago, they were 
      transported to an emergency department (ED). Confirmation of stroke diagnosis, 
      the rate of thrombolysis, and the time intervals between the call and hospital 
      arrival and imaging were assessed. Comparison used Fisher exact test. RESULTS: Of 
      the 271 patients transported to an NVU, 218 were diagnosed with a stroke (166 
      with ischemic stroke), 69 received thrombolytic therapy, and the mean 
      stroke-thrombolysis interval was 150 minutes. Of 64 patients admitted to the ED, 
      36 patients had a stroke (ischemic, 24). None were thrombolysed. Globally, 36% of 
      ischemic strokes were thrombolysed (27% of all strokes diagnosed). The mean 
      interval call-hospital was 65 minutes (ED vs NVU, P = .61). The interval 
      call-imaging was 202 minutes (interquartile range, 105.5-254.5) for ED and 92 
      minutes (interquartile range, 77-116) for NVU (P < .001). CONCLUSIONS: The 
      prehospital management of stroke by rescuers, under strict medical direction, 
      seemed to be feasible and effective for selection of patients with stroke in an 
      urban environment and may improve the access to thrombolysis.
CI  - Copyright (c) 2014 Elsevier Inc. All rights reserved.
FAU - Alhanati, Laure
AU  - Alhanati L
AD  - Fire Brigade of Paris, Emergency Medical Service, 1 Place Jules Renard, 75017 
      Paris, France.
FAU - Dubourdieu, Stephane
AU  - Dubourdieu S
AD  - Fire Brigade of Paris, Emergency Medical Service, 1 Place Jules Renard, 75017 
      Paris, France.
FAU - Hoffmann, Clement
AU  - Hoffmann C
AD  - Fire Brigade of Paris, Emergency Medical Service, 1 Place Jules Renard, 75017 
      Paris, France.
FAU - Beguec, Francis
AU  - Beguec F
AD  - Fire Brigade of Paris, Emergency Medical Service, 1 Place Jules Renard, 75017 
      Paris, France.
FAU - Travers, Stephane
AU  - Travers S
AD  - Fire Brigade of Paris, Emergency Medical Service, 1 Place Jules Renard, 75017 
      Paris, France.
FAU - Lefort, Hugues
AU  - Lefort H
AD  - Fire Brigade of Paris, Emergency Medical Service, 1 Place Jules Renard, 75017 
      Paris, France.
FAU - Maurin, Olga
AU  - Maurin O
AD  - Fire Brigade of Paris, Emergency Medical Service, 1 Place Jules Renard, 75017 
      Paris, France.
FAU - Jost, Daniel
AU  - Jost D
AD  - Fire Brigade of Paris, Emergency Medical Service, 1 Place Jules Renard, 75017 
      Paris, France.
FAU - Domanski, Laurent
AU  - Domanski L
AD  - Fire Brigade of Paris, Emergency Medical Service, 1 Place Jules Renard, 75017 
      Paris, France.
FAU - Tourtier, Jean-Pierre
AU  - Tourtier JP
AD  - Fire Brigade of Paris, Emergency Medical Service, 1 Place Jules Renard, 75017 
      Paris, France. Electronic address: medecinchef.bmu@pompiersparis.fr.
LA  - eng
PT  - Journal Article
DEP - 20140130
PL  - United States
TA  - Am J Emerg Med
JT  - The American journal of emergency medicine
JID - 8309942
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Emergency Medical Services/*organization & administration
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Paris
MH  - Prospective Studies
MH  - Stroke/*drug therapy
MH  - Thrombolytic Therapy/*methods
MH  - Time Factors
MH  - Transportation of Patients
MH  - Treatment Outcome
EDAT- 2014/03/13 06:00
MHDA- 2014/06/06 06:00
CRDT- 2014/03/12 06:00
PHST- 2013/10/09 00:00 [received]
PHST- 2014/01/02 00:00 [revised]
PHST- 2014/01/22 00:00 [accepted]
PHST- 2014/03/12 06:00 [entrez]
PHST- 2014/03/13 06:00 [pubmed]
PHST- 2014/06/06 06:00 [medline]
AID - S0735-6757(14)00064-3 [pii]
AID - 10.1016/j.ajem.2014.01.034 [doi]
PST - ppublish
SO  - Am J Emerg Med. 2014 May;32(5):438-42. doi: 10.1016/j.ajem.2014.01.034. Epub 2014 
      Jan 30.