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Enhanced dispatch and rendezvous doubles the catchment area and number of patients treated on a mobile stroke unit.
Parker, Stephanie A; Kus, Tessa; Bowry, Ritvij; Gutierrez, Nicole; Cai, Chunyan; Yamal, Jose-Miguel; Rajan, Suja; Wang, Mengxi; Jacob, Asha P; Souders, Christopher; Persse, David; Grotta, James C.
Afiliação
  • Parker SA; McGovern Medical School at the University of Texas Health Science Center, 6410 Fannin St, Suite 1423, Houston, TX 77030, United States. Electronic address: Stephanie.a.parker@uth.tmc.edu.
  • Kus T; McGovern Medical School at the University of Texas Health Science Center, 6410 Fannin St, Suite 1423, Houston, TX 77030, United States. Electronic address: tessa.kus@uth.tmc.edu.
  • Bowry R; McGovern Medical School at the University of Texas Health Science Center, 6410 Fannin St, Suite 1423, Houston, TX 77030, United States. Electronic address: Ritvij.bowry@uth.tmc.edu.
  • Gutierrez N; McGovern Medical School at the University of Texas Health Science Center, 6410 Fannin St, Suite 1423, Houston, TX 77030, United States. Electronic address: Nicole.r.gutierrez@uth.tmc.edu.
  • Cai C; McGovern Medical School at the University of Texas Health Science Center, 6410 Fannin St, Suite 1423, Houston, TX 77030, United States.
  • Yamal JM; School of Public Health at the University of Texas Health Science Center, Houston, TX, United States. Electronic address: jose-miguel.yamal@uth.tmc.edu.
  • Rajan S; School of Public Health at the University of Texas Health Science Center, Houston, TX, United States. Electronic address: suja.s.rajan@uth.tmc.edu.
  • Wang M; School of Public Health at the University of Texas Health Science Center, Houston, TX, United States. Electronic address: mengxi.wang@uth.tmc.edu.
  • Jacob AP; School of Public Health at the University of Texas Health Science Center, Houston, TX, United States. Electronic address: asha.jacob@uth.tmc.edu.
  • Souders C; Baylor College of Medicine, Houston, TX, United States. Electronic address: chris.souders@houstontx.gov.
  • Persse D; Baylor College of Medicine, Houston, TX, United States. Electronic address: david.persse@houstontx.gov.
  • Grotta JC; Memorial Hermann Hospital, Houston, TX, United States. Electronic address: james.c.grotta@uth.tmc.edu.
J Stroke Cerebrovasc Dis ; 29(8): 104894, 2020 Aug.
Article em En | MEDLINE | ID: mdl-32689599
INTRODUCTION: Mobile Stroke Units (MSUs) deliver acute stroke treatment on-scene in coordination with Emergency Medical Services (EMS). One criticism of the MSU approach is the limited range of a single MSU. The Houston MSU is evaluating MSU implementation, and we developed a rendezvous approach as an innovative solution to expand the range and number of patients treated. METHODS: In addition to direct 911 dispatch of our MSU to the scene within our 7-mile catchment area, we empowered more distant EMS units to activate the MSU. We also monitored EMS radio communications to identify possible patients. For these distant patients, the MSU met the EMS unit en route to the stroke center and treated the patient at that intermediate location. The distribution of the distance from MSU base station to site of stroke and time from 911 alert to tissue plasminogen activator (tPA) bolus were compared between patients treated on-scene and by rendezvous using Wilcoxon rank sum test. RESULTS: Over 4 years, 338 acute ischemic stroke patients were treated with tPA on our MSU. Of these, 169 (50%) were treated on-scene after MSU dispatch at a median of 6.4 miles (IQR 6.4 miles) from MSU base station. 169 (50%) were treated by 'rendezvous' pathway with assessment and treatment of stroke a median of 12.4 miles from base (IQR 5.5 miles) (p< 0.0001). Time (min) from MSU alert to tPA bolus did not differ: 36.0 ± 10.0 for on-scene vs 37.0 ± 10.0 with rendezvous (p=0.65). 13% of patients alerted via direct 911 dispatch were treated vs 44% of rendezvous patients. CONCLUSION: Adding a rendezvous approach to an MSU dispatch pathway doubles the range of operations and the number of patients treated by an MSU in an urban area, without incurring delay.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Tipo de estudo: Diagnostic_studies / Observational_studies / Prognostic_studies Limite: Aged / Aged80 / Female / Humans / Male / Middle aged País/Região como assunto: America do norte Idioma: En Ano de publicação: 2020 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Tipo de estudo: Diagnostic_studies / Observational_studies / Prognostic_studies Limite: Aged / Aged80 / Female / Humans / Male / Middle aged País/Região como assunto: America do norte Idioma: En Ano de publicação: 2020 Tipo de documento: Article