EMS World

OCT 2018

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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36 OCTOBER 2018 | EMSWORLD.com MOBILE STROKE CARE a neuroradiologist at Capital Health. Still at the scene, the crew contacts the stroke neurologist at Capital Health via a HIPAA- compliant video platform. The critical care nurse and neurologist then perform the NIHSS test. If the patient has no exclusion criteria, such as a recent heart surger y or being on blood-thinning medications, and imaging rules out a bleed in the brain, the ER physician will give the all- clear for the nurse to administer tPA to the patient while still in the MSU. Those with lower NIHSS scores are transported to a primar y stroke center, whereas higher-acuity patients can be taken to the nearest comprehensive stroke center for potential endovascular treatment if appropriate. "The standards and guidelines are changing ever y day, and we're tr ying to provide the patient with the best outcome by making sure we get them the best care and to the appropri- ate facility," says Boozan. Just days before this inter view, the American Hear t A ssociation /American Stroke A ssociation released new acute ischemic stroke care guidelines (w w w. ahajournals.org /doi/abs/ 10.1161/STR.0000000000000158). The most notable change in the guidelines was the extension of the treatment window from 6 hours to up to 24 hours after the last known normal, "with a really significant likelihood of improvement from endovascular therapy, so it's exciting for us," Boozan says. Like many EMS calls, a lot of the MSU calls are not as they were dispatched, leading to a high cancellation rate for the truck. "That's OK, because the idea is to catch the ones that mat- ter," says Boozan. At first the MSU only covered about 30% of Mercer County, but it achieved 100% coverage by December 2017, when all the other area hospitals were fully trained on accepting patients from the MSU. In total the MSU was dis- patched on 480 calls in its first year, which resulted in 125 full workups. Of those 125 patients, 22 received tPA. "You want to start this truck being ver y careful, meticulous, and doing things slowly and correctly rather than jump in and hope you do a good job," says Boozan. "We were never working on how many more we could get; it was 'Did we do it and do it right?' And make sure we're looking at what processes could change and improve." Commitment and Cost Stiefel believes the program is worth the investment. "There are different approaches to everything in life. You're either a leader or a follower, and Capital Health has always been that leader," he Mt. Everest FBAO TRAINING Because you can't always call 911 www.actfastmed.com For More Information Circle 30 on Reader Service Card

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