EMS World

FEB 2019

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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ISSUE FOCUS: CARDIAC AND STROKE CARE 32 FEBRUARY 2019 | EMSWORLD.com I n southeastern Australia a team of healthcare providers has launched a new initiative to improve care for patients with stroke by synchronizing all aspects of communication and treat- ment beginning the moment the patient is first seen by emergency personnel. Initial results have shown significant reductions in treatment times, potentially leading to improved outcomes for stroke victims. Stroke is a leading cause of death and disability worldwide, with 15 million indi- viduals experiencing one each year. Ever y nine minutes a person in Australia suf- fers from a new or recurrent stroke. The growing burden of stroke care around the globe highlights the need for advances in treatment, par ticularly rapid identifica- tion of symptoms and quick deliver y of definitive care. Time is a key factor in the treatment of acute ischemic stroke, as a few minutes gained or lost can make the dif ference between return to a normal life, perma- nent disability, or death. Treatments such as tissue plasminogen activator (tPA) and endovascular therapy can reperfuse vital brain tissue and minimize permanent dis- ability if administered quickly enough. Systems across the globe constantly evaluate and adjus t their s troke care models in efforts to decrease the time a stroke patient waits for definitive care. This inter val, often referred to as "door- to-needle time," is a critical factor in the long-term outcome for a patient experi- encing an acute ischemic stroke. The Limitations of Linear Care Currently most ischemic stroke patients in Australia are treated in a similar fash- ion, with communication and treatment both following a linear pattern. In the field the initial treating paramedic s a ssess the patient and identif y potential stroke symptoms. They then notif y the receiving facility's emergency department, usually via radio, that they are bringing in a patient who meets stroke team activation criteria. W h e n t h e a m b u l a n ce a r r i v e s t h e receiving hospital physician assesses the patient, and initial imaging is performed to rule out intracranial hemorrhage. When it is confirmed that the patient meets criteria for treatment, the rest of the hospital team, including the neurointerventional radiolo- gist and anesthesiologist, is alerted and begins preparing to treat the patient. This model creates a period of time— after the patient is identified as meeting treatment criteria but before treatment is initiated—when the patient waits in the emergency department, the reperfusion clock ticking away. Although implementa- tion of systemwide guidelines for stroke care has dramatically reduced this time in some systems, room for improvement remains. Mobile care coordination tech- nology offers a promising solution to the delays caused by a linear model of care . B y permitting members of the patient care team to communicate simultane- ously, mobile care coordination technol- ogy allows for multiple team members to begin their preparation and assessment at the s ame time, creating a parallel- process model. In Victoria, the Australian state that in clu d e s M elb o u r n e, B e n d igo H e alth Care Group, Ballarat Health Ser vices, and Ambulance Victoria, led by the Flo- rey Institute of Neuroscience and Men- tal Health, have partnered to use mobile care coordination technology to improve treatment for patients experiencing acute ischemic stroke. Their mobile technology platform, designed by Pulsara, is config- ured to allow rapid, simultaneous, and accurate transmission of critical infor- mation to all members of the care team. Florey professor Chris Bladin, PhD, a neurologist and director of stroke ser vices at Ambulance Vic toria, recognized an opportunity to use mobile technology to improve door-to-needle times for stroke patients. This opportunity is particularly relevant in the area's smaller regional hospitals, where a rotating junior medi- cal staff, limited specialists, and a lack of sophisticated infrastructure contribute to delays in patient care. "Some delays in care were inherently By Shawna Renga, AS, NREMT-P STOPPING STROKE DOWN UNDER How Australia is employing new technology to improve stroke coordination and care

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