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Abstracts of articles of Skyaid interest
Most
Journals were NOT available from Univ. of Wash. Medical Library
added
12/15/00
J Accid Emerg Med 2000 Nov;17(6):392-5
UW Med Lib does not subscribe to this
A national
census of ambulance response times to emergency calls in Ireland.
Breen N, Woods
J, Bury G, Murphy AW, Brazier H
Department of General
Practice, University College Dublin, The Coombe Healthcare Centre, Ireland.
Ann Emerg Med 1993 Aug;22(8):1254-7
Ambulance
arrival to patient contact: the hidden component of prehospital response time
intervals.
Campbell JP,
Gratton MC, Salomone JA 3d, Watson WA
Department of Emergency
Medicine, School of Medicine, University of Missouri-Kansas City.
Prehosp
Emerg Care
2000 Oct-Dec;4(4):327-32
UW Med Lib does not subscribe to this
Delays in the
EMS response to and the evacuation of patients in high-rise buildings in
Singapore.
Lateef F,
Anantharaman V
Department of Emergency
Medicine, Singapore General Hospital, Singapore. f_lateef@hotmail.com
BACKGROUND: Singapore is a
highly urbanized and cosmopolitan city situated at the crossroads of Southeast
Asia. High-rise buildings and "vertical living" are common, and the
city serves as a major business, financial, and industrial hub in the region.
More than 80% of the population live in high-rise apartments. This poses unique
problems and challenges for emergency ambulance services personnel in the access
to and evacuation of patients. OBJECTIVE: To estimate the arrival-to-patient
contact delay when accessing patients in high-rise buildings and evacuating them
to the hospital, compared with accessing patients in ground-level premises.
METHODS: This was a prospective study carried out from February 2 to March 1,
1998, for emergency calls from two of the busiest fire stations. The first 150
consecutive cases were enrolled into each of the two groups. Cases of road
traffic accidents were excluded because these did not require the crew to get
into a building. The times were clocked by one of the paramedics, using a
stopwatch. A high-rise building was defined as one where the crew had to ascend
at least one flight of stairs. A ground-level building did not involve any stair
climbing. We set forth to determine whether the interval between the following
was statistically significant when comparing high-rise vs ground-level premises:
1) time when the ambulance arrives at the scene (taken as the time when the
driver turns the engine off) and time of arrival at the patient's side; 2) time
of leaving the dwelling with the patient and time when the ambulance starts its
journey to the hospital (taken as the time when the driver starts the engine).
Data analysis was done with the use of SPSS, and the one-tailed unpaired
Student's t-test was used for significance testing, with the alpha error rate
set at 0.05. Results. One hundred fifty runs were analyzed for each group. The
mean delay from arrival to patient contact was 2.49 +/- 0.98 minutes for the
high-rise group compared with 1.02 +/- 1.41 minutes for the ground-level group
(difference was statistically significant with 95% CI: 1.20, 1.74 minutes; p =
0.0106). The mean delays from the time of leaving the building with the patient
to the time when the ambulance turned its engine on to start its journey to the
hospital were 3.24 +/- 1.58 minutes and 1.27 +/- 0.71 minutes for the two
groups, respectively (difference was statistically significant with 95% CI:
1.68, 2.04 minutes; p = 0.0098). CONCLUSION: There were significant delays
present when accessing patients in high-rise buildings and evacuating them to
the hospital. Modification to buildings and increasing public awareness and
education have been suggested to help minimize these delays.
Defibrillator/monitors allow
operators to assess and monitor a patient's ECG and, when necessary, deliver a
defibrillating shock to the heart. When integral noninvasive pacing capability
is added, the resulting device is referred to as a
defibrillator/monitor/pacemaker. In this Update Evaluation, we present our
findings for nine such units, including complete Product Profiles for two newly
evaluated models and update information for seven other models evaluated in our
May-June 1993 and February 1998 studies. We tested the two newly evaluated
models using the same basic protocol as in our previous studies. However, we did
add some new tests--and revise some old ones--to account for advances in the
technology. These advancements include the increasing use of advisory modes and
the increasing availability of expanded monitoring capabilities (which allow
units to function, at least to some degree, like a physiologic monitor). As in
our previous studies, we rated each model separately for three common
defibrillation applications: (1) general crashcart use, (2) in-hospital
transport use, and (3) prehospital use by emergency medical services (EMS)
personnel. Because each application requires its own set of capabilities, it's
not surprising that few models are appropriate for all applications. However, we
did identify three models that perform well--earning a rating of either
Acceptable or Preferred--in all three areas
The chain of
survival. A review in year 2000.
Gullo A,
Sallusti R, Trillo G
Department of Anesthesiology
and Intensive Care, Trieste University School of Medicine.
Worldwide about 1 in 1000
adults every year has a sudden cardiac arrest in out-of-hospital. That means
350,000-400,000 persons in the USA alone, 60,000 persons in Italy. Over 70% of
times sudden cardiac arrest occurs at home, the remaining 30% in public
settings. The chain of survival concept emphasizes four links associated with
survival after sudden cardiac arrest corresponding each with a set of actions
that have been done as soon as possible--the early access, the early CPR, the
early defibrillation, the early ACLS; in order to develop strength in each link,
separate specialized programs are needed, but all of the links must be well
connected. The Utstein Style was developed by a task force who suggested a
series of recommendations as a starting point for more effective exchange of
information about out-of hospital cardiac arrest. The Utstein Style includes a
glossary of terms, a template for reporting data from resuscitation studies on
cardiac arrest, definitions for time points and time intervals related to an
intervention in a resuscitation attempt, definitions of clinical items and
outcomes that should be included in reports, and recommendations for the
descriptions for how different EMS systems are organized.
Prehosp Emerg Care. 2000
Jul-Sep;4(3):270-2. No abstract available UW
Med Lib does not subscribe to this
Acute
stroke: implications for prehospital care. National Association of EMS
Physicians Standards and Clinical Practice Committee.
Developing an
emergency department team for treatment of stroke with recombinant tissue
plasminogen activator.
Gonzaga-Camfield
R
Department of Neurology,
Long Island Jewish Medical Center, New Hyde Park, New York, USA.
The EMS, ED, neurology,
radiology, nursing, laboratory, and pharmacy departments are integral parts of
the stroke team system. These are the key departments responsible for the
support of the stroke team, or nucleus, which emanates from the departments of
neurology and emergency medicine in the author's medical center. In the same way
that cardiac victims are treated for "heart attack," so stroke victims
should be treated for "brain attack." The emphasis on public awareness
to community outreach and senior citizens groups through the aid of the public
affairs department of the institution, the American Heart Association, and the
National Stroke Association (NSA) has been a tremendous lift in this, the decade
of the brain. The Public Broadcasting System and other television channels have
helped enormously in publicizing stroke signs and symptoms, new treatment of
stroke, and concurrent risk factors. New clinical research for thrombolytics and
neuro-protective agents are now in progress to determine the best treatment for
the damaged brain. The emphasis is changing: Time is brain. We hope to change
the expenditure attributable to rehabilitation and managed care after stroke to
the more hopeful prospects of prevention, early treatment, and fast recovery. We
can then see that our friends and family members, as victims of stroke, may
proceed to independence rather than long-term care facilities or nursing homes.
This will be possible only if hospitals and medical centers nationwide
adequately gear themselves for the treatment of ischemic stroke through the
creation of a core stroke team, finely-honed interdepartmental cooperation, and
the development of an efficient ED team that is fully immersed in the ethics and
protocol of "brain attack."
Acad
Emerg Med
1998 Jan;5(1):45-51
UW Med Lib does not subscribe to this
Rapid response
to stroke symptoms: the Delay in Accessing Stroke Healthcare (DASH) study.
Rosamond WD,
Gorton RA, Hinn AR, Hohenhaus SM, Morris DL
Department of Epidemiology,
School of Public Health, University of North Carolina, Chapel Hill, NC.
wayne_rosamond@unc.edu
OBJECTIVE: To assess the
determinants of prehospital delay for patients with presumed acute cerebral
ischemia (ACI) in order to provide the background necessary to develop
interventions to shorten such delays. METHODS: A prospective registry of
patients presenting to the ED with signs and symptoms of stroke was established
at a university hospital from July 1995 to March 1996. Trained nurses performed
a structured ED interview, which assessed prehospital delay and potential
confounders. RESULTS: The median delay (interquartile range) from symptom onset
to ED arrival for all patients seeking care for stroke-like symptoms (n = 152)
was 3.0 hours (1.5-7.8 hr). The median delay from symptom onset to ED arrival
was less in cases where a witness first recognized that there was a serious
problem than it was when the patient first identified the problem. A heightened
sense of urgency by the patient about his or her symptoms, and use of
911/emergency medical services (EMS) transport were also associated with rapid
arrival in the ED within 3 hours of symptom onset. After adjusting for all
predictor variables in a multivariable logistic regression model, only
recognition of symptoms by a witness and calling 911/EMS transport remained
statistically significant. CONCLUSIONS: These data suggest that future efforts
to intervene on prolonged prehospital delay for patients with ACI should include
strategies for the community as a whole as well as persons at risk for stroke
and should reinforce the use of 911 and EMS transport.
Stroke
2000 Nov;31(11):2591-6
Determinants of
use of emergency medical services in a population with stroke symptoms : the
second delay in accessing stroke healthcare (DASH II) study.
Schroeder EB,
Rosamond WD, Morris DL, Evenson KR, Hinn AR
Department of Epidemiology (E.B.S.,
W.D.R., K.R.E.), School of Public Health, and the Departments of Emergency
Medicine (D.L.M.) and Neurology (A.H.), School of Medicine, University of North
Carolina, Chapel Hill.
Background and
Purpose-With
the advent of time-dependent thrombolytic therapy for ischemic stroke, it has
become increasingly important for stroke patients to arrive at the hospital
quickly. This study investigates the association between the use of emergency
medical services (EMS) and delay time among individuals with stroke symptoms and
examines the predictors of EMS use. METHODS:-The Second Delay in Accessing
Stroke Healthcare Study (DASH II) was a prospective study of 617 individuals
arriving at emergency departments in Denver, Colo, Chapel Hill, NC, and
Greenville, SC, with stroke symptoms. RESULTS:-EMS use was associated with
decreased prehospital and in-hospital delay. Those who used EMS had a median
prehospital delay time of 2.85 hours compared with 4.03 hours for those who did
not use EMS (P:=0.002). Older individuals were more likely to use EMS (odds
ratio [OR] 1.21 for each 5-year increase, 95% CI 1.14 to 1.29), as were
individuals who expressed a high sense of urgency about their symptoms (OR 1.69,
95% CI 1.09 to 2.62). Knowledge of stroke symptoms was not associated with
increased EMS use (OR 0.63, 95% CI 0.40 to 0.98). Patients were more likely to
use EMS if someone other than the patient first identified that there was a
problem (OR 2.35, 95% CI 1.61 to 3.44). CONCLUSIONS:-Interventions aimed at
increasing EMS use among stroke patients need to stress the urgency of stroke
symptoms and the importance of calling 911 and need to be broad-based,
encompassing not only those at high risk for stroke but also their friends and
family.
A nationwide
prehospital stroke survey.
Crocco TJ,
Kothari RU, Sayre MR, Liu T
Department of Emergency
Medicine, University of Cincinnati, Ohio 45267-0769, USA. todd.crocco@uc.edu
OBJECTIVES: To identify
deficiencies in stroke knowledge among prehospital providers. METHODS: A
nationwide multiple-choice survey was sent to 689 paramedics (EMT-Ps) and 294
advanced EMTs (EMT-Is) from a random selection of the National Registry of
Emergency Medical Technicians database. Of the 23 questions, five addressed
demographic information, four quantity of training, five general knowledge, 6
and seven management, and two open-ended questions addressed the signs,
symptoms, and risk factors of stroke. The EMT-P and EMT-I answers were compared
using chi-square analysis or Fisher's exact test. RESULTS: Of the 355 (36%)
respondents, 256 (72%) were EMT-Ps and 99 (28%) were EMT-Is. Virtually all the
EMT-Ps (99%) and EMT-Is (98%) knew that a stroke injures the brain, but only 199
(78%) of the EMT-Ps and 47 (47%) of the EMT-Is correctly defined a transient
ischemic attack (TIA) (p < 0.001). Slurred speech, weakness/ paralysis, and
altered mental status were the three most commonly cited symptoms of stroke by
both groups. The EMT-Ps were more likely to recognize that dextrose is
potentially harmful to stroke patients [EMT-P = 216 (85%), EMT-I = 71 (72%), p =
0.005]; 169 (66%) of the EMT-Ps and 75 (76%) of the EMT-Is felt that elevated
blood pressures should be lowered in the prehospital setting. Only 93 (36%) of
the EMT-Ps and 22 (22%) of the EMT-Is knew that tissue plasminogen activator
(tPA) must be given within three hours of symptom onset (p = 0.01). CONCLUSION:
Most EMS providers are knowledgeable about the symptoms of stroke but are
unaware of the therapeutic window for thrombolysis and the recommended avoidance
of prehospital blood pressure reduction. In addition, further education is
needed regarding TIAs
Acute
ischemic stroke.
Hall P
Washington State University,
USA.
To optimize the recovery
outcome of those with acute ischemic stroke, several steps need to be taken and
strengthened by the public and medical personnel. These include immediate
identification of stroke symptoms and appropriate actions, quick access to EMS,
rapid EMS response, treatment and evacuation, early communication to the medical
facility, rapid diagnosis and interventions, specialized treatment, evaluation
of complications, precipitating and accompanying factors, and appropriate
rehabilitation when applicable.
Ensuring
the chain of recovery for stroke in your community.
Pepe PE,
Zachariah BS, Sayre MR, Floccare D
Allegheny University of the
Health Sciences, Allegheny University Hospitals, Allegheny General, Pittsburgh,
PA 15212-4772, USA. ppepe@aherf.edu
Until recently, the
prehospital and ED management of nonhemorrhagic stroke was largely supportive
care. Studies have now demonstrated the potential of certain therapeutic
interventions to reverse the debilitating consequences of such strokes. The
clinical benefit for such interventions and the risk of significant therapeutic
complications are highly time-dependent. To optimize the chances of a better
outcome for the patient with stroke, each community must establish and continue
to refine a chain of recovery for stroke patients. The chain of recovery is a
metaphor that describes a series of sequential actions that must take place in a
timely fashion to optimize the chances of recovery from stroke. Each of these
sequential actions forms an individual link in the chain, and each link must be
intact. The links include: identification of the onset of stroke symptoms by the
patient or bystanders; dispatch life support services, which preferably include
enhanced 9-1-1 and medically supervised and trained dispatchers who can rapidly
deploy the closest responders and transport units; emergency medical services
(EMS) personnel who can rapidly assess and transport the stroke patient to the
closest appropriate center capable of providing advanced stroke diagnostics and
interventions; en route notification of the receiving facility so that
appropriate personnel can be readied for rapid diagnosis and intervention; and
receiving facilities capable of providing rapid diagnosis and advanced treatment
of stroke, including the availability of specialists who can evaluate underlying
etiologies as well as plan future therapies and rehabilitation. To ensure that
the chain of recovery is in place, aggressive public education campaigns should
be implemented to increase the probability that stroke symptoms and signs will
be recognized as soon as possible by patients and bystanders. In addition,
because most of the current training programs for EMS dispatchers and EMS
personnel are lacking with regard to stroke, it is recommended that such
personnel and their EMS system managers be updated on current management and
treatment strategies for stroke.
Feasibility
and safety of inducing modest hypothermia in awake patients with acute stroke
through surface cooling: A case-control study: the Copenhagen Stroke Study.
Kammersgaard
LP, Rasmussen BH, Jorgensen HS, Reith J, Weber U, Olsen TS
Department of Neurology,
Bispebjerg, Copenhagen, Denmark. kammersgaard@dadlnet.dk
BACKGROUND AND
PURPOSE:
Hypothermia reduces neuronal damage in animal stroke models. Whether hypothermia
is neuroprotective in patients with acute stroke remains to be clarified. In
this case-control study, we evaluated the feasibility and safety of inducing
modest hypothermia by a surface cooling method in awake patients with acute
stroke. METHODS: We prospectively included 17 patients (cases) with stroke
admitted within 12 hours from stoke onset (mean 3.25 hours). They were given
hypothermic treatment for 6 hours by the "forced air" method, a
surface cooling method that uses a cooling blanket with a flow of cool air (10
degrees C). Pethidine was given to treat compensatory shivering. Cases were
compared with 56 patients (controls) from the Copenhagen Stroke Study matched
for age, gender, initial stroke severity, body temperature on admission, and
time from stroke onset to admission. Blood cytology, biochemistry, ECGs, and
body temperature were monitored during hypothermic treatment. Multiple
regression analyses on outcome were performed to examine the safety of
hypothermic therapy. RESULTS: Body temperature decreased from t(0)=36.8 degrees
C to t(6)=35.5 degrees C (P:<0.001), and hypothermia was present until 4
hours after therapy (t(0)=36.8 degrees C versus t(10)=36.5 degrees C; P:=0.01).
Mortality at 6 months after stroke was 12% in cases versus 23% in controls
(P:=0. 50). Final neurological impairment (Scandinavian Stroke Scale score at 6
months) was mean 42.4 points in cases versus 47.9 in controls (P:=0.21).
Hypothermic therapy was not a predictor of poor outcome in the multivariate
analyses. CONCLUSIONS: Modest hypothermia can be achieved in awake patients with
acute stroke by surface cooling with the "forced air" method, in
combination with pethidine to treat shivering. It was not associated with a poor
outcome. We suggest a large, randomized clinical trial to test the possible
beneficial effect of induced modest hypothermia in unselected patients with
stroke.
Cooling therapy
for acute stroke.
Correia M,
Silva M, Veloso M
Neurology Department,
Hospital Geral de Santo Antonio, Largo Prof Abel Salazar, Porto, Portugal, 4050.
nedcv@mail.telepac.pt
BACKGROUND: Recent studies
in acute stroke patients have shown an association between body temperature and
prognosis. OBJECTIVES: Our objective was to assess the effects of cooling when
applied to patients with acute ischaemic stroke or primary intracerebral
haemorrhage. SEARCH STRATEGY: We searched the Cochrane Stroke Group's trial
register (last searched in March 1999), plus MEDLINE searched up to November
1998 and EMBASE searched from January 1980 to November 1998. We contacted
investigators, pharmaceutical companies and manufacturers of cooling equipment
in this field. SELECTION CRITERIA: All completed randomised controlled trials or
controlled clinical trials, published or unpublished, where cooling therapy
(therapy given by physical devices or antipyretic drugs primarily to lower body
temperature independently of basal temperature at the beginning of treatment)
was applied up to two weeks of an acute ischaemic stroke or primary
intracerebral haemorrhage. DATA COLLECTION AND ANALYSIS: Two reviewers
independently searched for relevant trials. MAIN RESULTS: No randomised trials
or controlled trials were identified; one placebo-controlled trial of metamizol
is currently underway. REVIEWER'S CONCLUSIONS: There is currently no evidence
from randomised trials to support the routine use of physical or chemical
cooling therapy in acute stroke. Since experimental studies showed a
neuroprotective effect of hypothermia in cerebral ischaemia, and hypothermia
appears to improve the outcome in patients with severe closed head injury,
trials with cooling therapy in acute stroke are warranted.
EMS UW Med Lib does not subscribe to this
J Card. Failure Sept 96 UW Med Lib does not subscribe to this
J Cardiovascualr Elect Feb 2000 UW Med Lib does not subscribe to this
J of Telemedicine UW Med Lib does not subscribe to this
Phys Med Rehabil Clin N Am - - - - - - - UofW?
Status of functional outcomes for stroke survivors. 1999 Nov;10(4):957-66. Review.
Stroke. Neurologic and functional recovery the Copenhagen Stroke Study. 1999 Nov;10(4):887-906. Review.
Air Med J (no U of W) - - - - - - -
Pilot study for predicting appropriate use of air medical helicopters. Part 1: Interfacility transports. 2000 Apr-Jun;19(2):59-65. No abstract
Justifying cardiac transports. 2000 Apr-Jun;19(2):37. No abstract
J Insur Med. (no U of W) Morbidity and mortality associated with stroke 1996;28(1):13-22. Review. No abstract available
J Hum Hypertens (no U of W) Fifty years of Framingham Study contributions to understanding hypertension. 2000 Feb;14(2):83-90. Review
Cardiovasc Drugs Ther. no U of W 1999 Apr;13(2):95-104. Review. Cardiovascular disease in developing countries: myths, realities, and opportunities.
Cerebrovasc Dis. No U of W 1999 Nov-Dec;9(6):320-2. Stroke during sleep: epidemiological and clinical features.
Eur J Emerg Med. No U of W 1999 Mar;6(1):61-9. Review. Stroke--a medical emergency.
Indian J Med Res. No U of W 1997 Oct;106:325-32. Review. Strokes in the elderly: prevalence, risk factors & the strategies for prevention.
Manag Care Q. No U of W 2000 Winter;8(1):38-43. "Low-tech" personal emergency response systems reduce costs and improve outcomes.
Prehosp Emerg Care. No U of W 1999 Jul-Sep;3(3):201-6. A nationwide prehospital stroke survey.