Effect of Implementation of Helicopter EMS (HEMS) for Scene Response to Acute Stroke Patients on Time to Primary Stroke Centers in Central Virginia

Background: Stroke is the third leading cause of death and first leading cause of disability in the US. Direct and indirect costs in 2009 were approximately $68.9 billion. In recent years, therapeutic recannulation options for acute ischemic stroke have advanced dramatically. However, only 3-5% of eligible patients reach the hospital in time to potentially benefit from these therapies. This percentage is further diminished in rural areas due to a lack of access to acute care hospitals and primary stroke centers (PSC).

Objective/Purpose: The purpose of this study was to determine the impact of a coordinated effort between rural ground EMS and LifeEvac of Virginia (LEV) HEMS personnel to rapidly identify and transport patients with symptoms of an acute stroke to a PSC.

Methods: Two years ago, LEV initiated an educational campaign for rural EMS providers that focused on the importance of rapid recognition and transport of stroke patients presenting within three hours of symptom onset. A 2-year retrospective chart review was performed to evaluate how many patients with acute stroke like symptoms were flown from rural areas to PSCs by LEV and the time from symptom onset to arrival at the PSC.

Results: Forty-three cases were identified that met symptoms of a possible acute stroke in which rural EMS providers requested LEV. All 43 of these patients presented within three hours of symptom onset. All patients were transported to a PSC for further evaluation, workup, and possible intervention.

Discussion/Conclusions: Although the overall number of transports in this sample is small, our study suggests that that with a targeted program and utilization of a regional HEMS service, it is possible to recognize and transport patients with symptoms of acute stroke to a PSC in time to assess eligibility for and implement recannulation therapy if indicated.