Effects of Emergency Medical Services Stroke Center Routing on Sites of Care and Enrollment in a Prehospital Research Study: The FAST-MAG Experience

Background: Emergency Medical Services (EMS) routing of acute stroke patients to designated stroke centers has the potential to increase the proportion of patients receiving care at facilities meeting national standards and to augment recruitment rates for prehospital stroke research.Methods: We analyzed a prehospital stroke treatment trial dataset to determine the number of patients cared for at certified primary stroke centers (PSC), prehospital care time intervals, and trial enrollment rates prior to and following implementation of a Los Angeles County-wide regional acute stroke care system in November 2009, with preferential routing of likely acute stroke patients, within 2 hours of symptom onset, to designated centers PSC certification. Analyses were performed in the overall study (1/2005 to 12/2012) as well as the period encompassing the year before and after implementation.Results: There were 863 subjects enrolled in LA County before and 764 after EMS routing and proportion transported to PSC increased substantially, from 10% prior to 91% following implementation (Pu003c0.001). Routing was associated with a slight decrease in total time from paramedic on-scene to ED arrival, 34.5 minutes (SD 9.1) vs. 33.5 (SD 10.3), p=0.045. When comparing the year before to the year after implementation, enrollment increased by 18.6%, (215 at 44 hospitals vs. 255 at 27 hospitals), and proportion transported to PSC increased from 17% to 88%. During the study, the number of PSCs increased from 1 in 2005 to 28 in 2012, including from 7 to 17 in the year before to the year after EMS routing policy adoption.Conclusions: The establishment of a regionalized EMS system of acute stroke care dramatically increased the proportion of acute stroke patients cared for at Primary Stroke Centers, from 1 in 10 to more than 9 in 10, with no increase in prehospital care times, and enhanced recruitment of patients into an ongoing prehospital stroke trial.