Abstract W P190: Emergency Medical Services Protocols for Routing Stroke Patients to Designated Stroke Center Hospitals
Background: Stroke systems of care include routing patients to the nearest designated stroke center hospital, bypassing non-designated hospitals. Routing protocols are implemented at the state or county level and vary in qualification criteria and determination of destination hospital. We surveyed all counties in the state of California for presence and characteristics of their prehospital stroke routing protocols.
Methods: Each county in California was queried for the presence of a stroke routing protocol. These protocols were obtained and reviewed for method of stroke identification and criteria for patient transport to a stroke center.
Results: Thirty-three local EMS agencies (LEMSAs) serve 58 counties in California with populations ranging from 1175 to almost 10 million (mean 642,000), area ranging from 47 to 20,000 sq. mi (mean 2690) and population density 2 to 17,000 persons per sq. mi (mean 661). Fifteen LEMSAs (45%) had stroke routing protocols, covering 23 counties (40%) and 68% of the state population. Counties with protocols had higher population density (1500 vs. 140 persons per sq. mi). All protocols designated a time period from symptom onset to EMS evaluation to qualify for routing, median 3 hr (IQR 2.5-4, range 2 - 8). Twelve of 23 (52%) allowed a maximum transport time of 30 minutes to qualify for diversion. The number of LEMSA-designated stroke hospitals per county in jurisdictions with diversion was median 2 (IQR 0-7, range 0 - 29). In the six counties without designated stroke centers, patients meeting criteria were transported out of county. Stroke identification in the field among diverting LEMSAs was achieved using the CPSS/FAST in 23, the LAPSS in 2, county-specific protocol in 7, and not stated in 1.
Conclusion: California EMS stroke routing protocols cover 68% of the state population and vary in characteristics including activation by symptom onset time and destination facility features, reflecting matching of system design to local geographic resources.
Author Disclosures: N. Dimitrov: None. W. Koenig: None. N. Bosson: None. S. Song: None. J.L. Saver: None. N. Sanossian: None.
- © 2014 by American Heart Association, Inc.