142nd APHA Annual Meeting and Exposition

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309957
Linking Stroke Patient Hospital Data to EMS Records: Potential for Using Prehospital Indicators to Improve Stroke Diagnosis and Treatment

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014 : 12:45 PM - 1:00 PM

Amelia Kenner Brininger, MPH, CPH , Emergency Medical Services, County of San Diego, San Diego, CA
Barbara M. Stepanski, MPH , Emergency Medical Services, County of San Diego Health and Human Services Agency, San Diego, CA
Diane Royer, RN, BSN , County of San Diego, Emergency Medical Services, San Diego, CA
Bruce Haynes, MD , Emergency Medical Services, County of San Diego Health and Human Services Agency, San Diego, CA
Leslie Ray, MPH, MPPA, MA , Emergency Medical Services, County of San Diego Health and Human Services Agency, San Diego, CA
Sanaa Abedin, MPH , Community Health Statistics Unit, Health Care Policy Administration, County of San Diego Health and Human Services Agency, San Diego, CA
Alicia Sampson, MPH, CPH , Health & Human Services Agency, Public Health Services, County of San Diego, San Diego, CA
Joshua Smith, PhD, MPH , Emergency Medical Services, County of San Diego Health and Human Services Agency, San Diego, CA
Isabel Corcos, PhD, MPH , County of San Diego, Emergency Medical Services, County of San Diego, San Diego, CA
Ryan Smith, MPH , Emergency Medical Services, County of San Diego, San Diego, CA
Audio (mp3) recording Recorded Presentation (mp4)
Background: Seeking treatment at the first signs of a stroke has been shown to greatly improve patient outcome. The Emergency Medical System (EMS) plays an important role in expediting treatment. Annually, there are more than 4,100 EMS transports for a possible stroke in San Diego County and 2,700 EMS-transported stroke cases treated at a Stroke Receiving Center (SRC). However, it was not possible to assess trends in EMS-transported stroke cases treated at a SRC until now.

Methods: All EMS-transported stroke cases from the SRC System Database were linked by a common identifier to their corresponding EMS record for 2011-2012. EMS fields were analyzed by stroke diagnosis to assess trends in patient situations and EMS treatment.

Results: Among EMS-transported stroke patients, 50 unique provider impressions (PIs) were used to describe the patient’s situation. The most common PI for intracerebral hemorrhage (ICH), ischemic stroke (AIS), and transient ischemic attack (TIA) was “Neurologic Deficit (includes CVA/TIA) within 2 hours”. Subarachnoid hemorrhage (SAH) was most commonly described as “Headache”. 24.0% of ICH cases, 14.8% of AIS cases, 21.6% of SAH cases, and 10.4% of TIA cases were acute. The most common EMS skill performed was pulse oximetry; the most common medication administered was saline.

Conclusion: Determining trends in PIs, treatment, and medications provides data on how stroke cases are handled and identified during EMS transport. As the State of California develops SRC system regulations, ongoing analysis will be essential for enhancing the evidence base to develop new prehospital policies and education for EMS personnel.

Learning Areas:

Chronic disease management and prevention
Clinical medicine applied in public health

Learning Objectives:
Identify the benefit of linking EMS patient records with stroke patient’s hospital records. Name EMS indicators that can build the evidence base to enhance stroke-related prehospital policies, procedures, and education.

Keyword(s): Strokes, Emergency Medical Services

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to be the author of this abstract because I work as the epidemiologist for the Stroke Receiving System Database for the County of San Diego Emergency Medical Services.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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