Background: In June of 2015 we revised the County-Level Emergency Medical Services (EMS) protocol and algorithm to include the Rapid Arterial oCclusion Evaluation (RACE) scale in addition to the Cincinnati Prehospital Stroke Scale (CPPS) to determine if first responders could differentiate between which stroke patients could benefit from endovascular treatment using this simple algorithm. Preliminary data showed that first responders can accurately differentiate between which stroke patients could benefit from endovascular treatment but does it increase treatment rates and decrease treatment times?
Purpose: To determine if first responders transporting stroke patients to the closest Interventional Stroke Center for treatment increased the number of stroke patients receiving interventional treatment and/or intravenous tissue plasminogen activator (IV tPA) and does door to needle and door to computerized axial tomography scan (CT) times decrease?
Method: We analyzed the number of thrombectomies done and the number of patients receiving IV tPA from July 2014 to June 2015 (before implantation of the RACE protocol) compared to July 2015 to June 2016 (after implantation of the RACE protocol) and examined our door to needle and door to CT scan times over the same period.
Results: EMS brought 56 ischemic stroke patients to our primary stroke center from July 2014 to June 2015. 10 patients received IVtPA (17.8%) and 5 underwent thrombectomies (8.9%). EMS brought 83 ischemic stroke patients to our primary stroke center from July 2015 to June 2016 using the RACE protocol. 29 patients received IVtPA (34.9%) and 18 underwent thrombectomies (21.7%). Our door to needle times for IVtPA decreased from a median of 64 minutes to 37 minutes, and door to CT times decreased from a median of 24 minutes to 13 minutes over the same time period.
Conclusion: Our data suggests that if first responders transport patients using the RACE protocol, a greater percentage of stroke patients will be eligible for endovascular treatment and use of IV tPA and treatment times can also be improved. Future evaluation could measure the outcomes of these patients using the Modified Rankin Score (mRS).