Objective: The Field Assessment Stroke Triage for Emergency Destination (FAST-ED) is a pre-hospital screening tool used to detect large vessel occlusion (LVO) strokes. FAST-ED was implemented by Miami-Dade Fire Rescue (MDFR) in March 2017 with a goal to bring potential LVO patients directly to a Comprehensive Stroke Center (CSC) and activate the endovascular team from the field. In this project, we assessed whether use of the FAST-ED increased the distance patients traveled, assuming some of these patients would bypass a primary or acute stroke ready center to come to a CSC.
Method: This is a retrospective hospital quality study examining distance traveled by MDFR for acute stroke alerts. Data from three periods were compared: (A) Mar-May 2017 after implementation of FAST-ED, (B) Mar-May 2016, the year before implementation, and (C) Dec 2016-Feb 2017, just before implementation. Distance traveled in miles from scene to our CSC was obtained from MDFR incident reports. Data also were broken down by age (<80 vs. ≥80 years).
Results: In total, 429 acute stroke alerts brought by MDFR to our CSC were reviewed. There were 138 cases in Period A, 136 in Period B, and 155 in Period C. Out of those cases, 156 were aged ≥80 years; 49/138 (36%) in Period A, 45/136 (33%) in Period B, and 62/155 (40%) in Period C. A two-factor ANOVA was used to determine if there was an effect of FAST-ED implementation and age on distance traveled. Patients ≥80 years traveled statistically significantly shorter distances (7.0 mi) than those <80 (9.0 mi), regardless of time period [F(1,5)=13.70, p<0.001]. There was a marginally significant period x age interaction [F(2,5)=2.35, p=0.09] such that people ≥80 traveled further in Period A compared to Period B (7.8 mi vs. 5.8 mi, p<0.05), whereas people <80 traveled less far in Period A compared to Period C (8.2 mi vs. 10.0 mi, p<0.05). No main effect of period was found.
Conclusion: Implementation of a FAST-ED EMS initiative to bypass to a CSC did not lead to an overall increase in distance traveled. However, the effect was different depending on whether the patient was over 80 years old or not. These results are interesting because FAST-ED does not have age as a component, but age may contribute to on-the-spot MDFR triaging decisions.