The Feasibility of Neuroprotective Agent Administration by Pre-hospital Personnel in an Urban Setting
Previous studies have demonstrated the importance of early stroke recognition and treatment. Emergency medical service (EMS) personnel are often the stroke patient’s first contact with medical personnel. If clinical trials involving neuroprotective agents (NAs) are successful, prehospital initiation of NAs may allow early administration of these agents. Objective: To determine the potential time reduction to administration of NAs if initiated by EMS personnel in the urban prehospital setting. Method: 23 urban EMS agencies volunteered to participate in this study. Prehospital personnel completed a stroke assessment checklist on any patient considered to be a potential stroke victim. The checklist collected demographic information, clinical inclusion/exclusion criteria for NA administration (including a prehospital stroke scale), and event/decision times. The time data included: scene arrival, scene departure, emergency department (ED) arrival, and estimated time of NA administration. Patients with checklists meeting the hypothetical clinical inclusion criteria (but none of the exclusion criteria) and with completed time data were enrolled in this study. Data analyses were performed using regression analysis and Student’s t-test. Results: Of the 30 patients enrolled in this study to date, 13 met criteria to receive NAs. On average, EMS personnel documented the theoretical NA administration 9.8±7.6 minutes prior to ED arrival (during a mean prehospital course of 33±12 minutes). In 6 cases, the NA would have been administered on scene and the remainder en route to the hospital. The EMS providers’ years of experience did not affect the theoretical NA administration time (p=0.705). Study enrollment continues, and approximately 100 enrolled patients are expected by January 1, 2001. Accuracy of EMS stroke recognition will be included in the final analysis. Conclusion: In the urban prehospital setting, all patients deemed eligible for NA administration could have been initiated on this therapy by EMS personnel prior to ED arrival.