A validated pre-hospital assessment tool to detect severe strokes including intracranial hemorrhages and large vessel occlusions along with protocols for bypassing to comprehensive stroke centers remains an ongoing debate.
The long term goals align with the emphasis of developing formalized stroke severity adjusted EMS triaging and bypass protocols to recognize both large vessel ischemic and intracerebral hemorrhagic stroke patients early in the pre-hospital setting with the utilization of a recognized, validated assessment tool, formal bypass criteria protocols, and formalized training for emergency medical service personnel. These goals align with the topic of careful selection of patients who meet strict criteria for bypassing acute stroke ready and primary stroke centers throughout the Southeastern New Jersey region which includes one acute ready hospital and two primary stroke centers to the closest Comprehensive Stroke Center in Atlantic City, New Jersey. The first specific aim is to analyze the EMS field diagnostic accuracy completed by both AtlantiCare EMS ACLS providers and Mid Atlantic Medevac EMS personnel. A therapeutic bypass yield will be analyzed in order to determine the effectiveness of the formalized training to conduct effective stroke severity EMS triaging assessments and a formal bypass protocol to the Comprehensive Stroke Center in Atlantic City, New Jersey. Sensitivity results of the near-infrared (NIR) technology device as a pre-scanning tool for hemorrhages prior to CT scan and operator error will be analyzed. Final diagnosis, CT results, and the need for comprehensive services will serve as the sole factor for the therapeutic bypass yield analysis.
The second aim is to analyze the percentage of bypassed patients to the Comprehensive Stroke Center that undergo comprehensive interventions or medical services.
Policy/Protocol Design (refer to images)
IRB Information: FWA#00011915 and RP# 15-039ex IRB