134 Effect of EMS Stroke Code on Total Out-of-Hospital Time

Stroke is a time dependent medical emergency responsible of an important burden of morbidity and mortality in Argentina. Patient's access to an expedited medical treatment and recanalization therapy requires the coordinated action of the pre- and in-hospital teams to improve the results. We present the impact of a structured EMS Stroke Protocol on total prehospital times. Demonstrate that an EMS Stroke Protocol is an effective strategy to reduce prehospital delay to access a Stroke Receiving Hospital. Observational, retrospective, cross-sectional and descriptive study based on records comparing clinical records of stroke calls to our EMS; we form two groups: a pre-protocol sample ranging between 09/01/2017 to 03/31/2018 and protocol collected sample through the App Stroke Code v1.0 (internal development) from 09/01/2018 to 01/31/2019. n=430 (226 pre-protocol and 204 post-protocol records). There are no differences between two groups in sex, age and geographical distribution. The data was transferred to a Microsoft Excel spreadsheet and to Epi Info v7.2.2.1 for analysis. Our EMS Stroke code includes a prioritized dispatch system, the development of a proprietary Stroke Code APP with basic instructions for the prehospital team according to AHA Stoke 2018 Guidelines (Cincinnati Scale, Capillary glucose measure, oxygen if SpO2 <94, etc.) and Angels Initiative Emergency Response Teams Checklists. The app includes an all-time-visible timer. Finally, the protocol has pre-selected Stroke Receiving hospitals and pre-notifies them with Estimated Time of Arrival. In total we registered a sample of 430 stroke calls. The mean patient age was 79 y/o, 57% were female. The mean arrival time before protocol was 10.2 minutes and post-protocol 10.6 minutes (p0.1). The mean medical time (at patient home + transport to the Stroke receiving hospital) was 54 minutes pre-protocol and 41.6 minutes post protocol (p0.0039). The total prehospital time (arrival+total medical time) was 64 minutes pre-protocol and 52 minutes post-protocol (p0.0036). Developing an EMS Stroke protocol improves the total prehospital time significatively. Interestingly, in our series, the arrival time didn't change after the implementation of the Stroke Protocol, this can be explained in part for the state of art dispatch system already installed on our EMS, but also, for geographical, traffic congestion and logistical issues.