Abstract:
:IntroductionIschemic stroke treatment is time-sensitive, and barriers to providing prehospital care encountered by Emergency Medical Services (EMS) providers have been under-studied.Hypothesis/ProblemThis study described barriers to providing prehospital care, identified predictors of these barriers, and assessed the impact of these barriers on EMS on-scene time and administration of tissue plasminogen activator (tPA) in the emergency department (ED). METHODS:A retrospective cohort study was performed using the Get With The Guidelines-Stroke (GWTG-S; American Heart Association [AHA]; Dallas, Texas USA) registry at two hospitals to identify ischemic stroke patients arriving by EMS. Variables were abstracted from prehospital and hospital medical records and merged with registry data. Barriers to care were grouped into themes. Logistic regression was used to identify predictors of barriers to care, and bi-variate tests were used to assess differences in EMS on-scene time and the proportion of patients receiving tPA between patients with and without barriers. RESULTS:Barriers to providing prehospital care were documented for 15.5% of patients: 29.6% related to access, 26.7% communication, 23.0% extrication and transportation, 20.0% refusal, and 14.1% assessment/management. Non-white and non-black race (OR: 3.69; 95% CI, 1.63-8.36) and living alone (OR: 1.53; 95% CI, 1.05-2.23) were associated with greater odds of barriers to providing care. The EMS on-scene time was ≥15 minutes for 70.4% of patients who had a barrier to care, compared with 49.0% of patients who did not (P<.001). There was no significant difference in the proportion of patients who were administered tPA between those with and without barriers to care (14.1% vs 19.2%; P=.159). CONCLUSIONS:Barriers to providing prehospital care were documented for a sizable proportion of ischemic stroke patients, with the majority related to patient access and communication, and occurred more frequently among non-white and non-black patients and those living alone. Although EMS on-scene time was longer for patients with barriers to care, the proportion of patients receiving tPA in the ED did not differ. LiT, CushmanJT, ShahMN, KellyAG, RichDQ, JonesCMC. Barriers to providing prehospital care to ischemic stroke patients: predictors and impact on care. Prehosp Disaster Med. 2018;33(5):501-507.
journal_name
Prehosp Disaster Medjournal_title
Prehospital and disaster medicineauthors
Li T,Cushman JT,Shah MN,Kelly AG,Rich DQ,Jones CMCdoi
10.1017/S1049023X18000766subject
Has Abstractpub_date
2018-10-01 00:00:00pages
501-507issue
5eissn
1049-023Xissn
1945-1938pii
S1049023X18000766journal_volume
33pub_type
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journal_title:Prehospital and disaster medicine
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abstract:INTRODUCTION:The ever-present risk of mass casualties and disaster situations may result in airway management situations that overwhelm local emergency medical services (EMS) resources. Endotracheal intubation requires significant user education/training and carries the risk of malposition. Furthermore, personal protec...
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journal_title:Prehospital and disaster medicine
pub_type: 杂志文章,评审
doi:
更新日期:2000-01-01 00:00:00
abstract:BACKGROUND:Following the recommendations of the World Association for Disaster and Emergency Medicine (WADEM; Madison, Wisconsin USA) to develop standards for training the undergraduates in disaster-relevant fields (2004), a German curriculum was approved in 2006. This paper aims to describe the level of training and i...
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journal_title:Prehospital and disaster medicine
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journal_title:Prehospital and disaster medicine
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journal_title:Prehospital and disaster medicine
pub_type: 杂志文章,评审
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journal_title:Prehospital and disaster medicine
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journal_title:Prehospital and disaster medicine
pub_type: 杂志文章
doi:10.1017/s1049023x00005136
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abstract:INTRODUCTION:Anecdotal observations about prehospital emergency medical care in major natural and human-made disasters, such as earthquakes, have suggested that some injured victims survive the initial impact, but eventually die because of a delay in the application of life-saving medical therapy. METHODS:A multidisci...
journal_title:Prehospital and disaster medicine
pub_type: 杂志文章
doi:10.1017/s1049023x00041005
更新日期:1994-04-01 00:00:00
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journal_title:Prehospital and disaster medicine
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更新日期:2016-12-01 00:00:00
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更新日期:2005-03-01 00:00:00
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journal_title:Prehospital and disaster medicine
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journal_title:Prehospital and disaster medicine
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journal_title:Prehospital and disaster medicine
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journal_title:Prehospital and disaster medicine
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journal_title:Prehospital and disaster medicine
pub_type: 杂志文章,评审
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更新日期:2015-02-01 00:00:00
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journal_title:Prehospital and disaster medicine
pub_type: 杂志文章
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更新日期:2017-08-01 00:00:00
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journal_title:Prehospital and disaster medicine
pub_type: 杂志文章
doi:10.1017/S1049023X12001288
更新日期:2012-12-01 00:00:00
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journal_title:Prehospital and disaster medicine
pub_type: 杂志文章
doi:
更新日期:2006-01-01 00:00:00
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journal_title:Prehospital and disaster medicine
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更新日期:2020-12-01 00:00:00
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journal_title:Prehospital and disaster medicine
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更新日期:2017-06-01 00:00:00
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journal_title:Prehospital and disaster medicine
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