Department of Emergency Medicine, University of California San Francisco, San Francisco, CaliforniaUSA.
Department of Neurology, University of California San Francisco, San Francisco, CaliforniaUSA.
Prehosp Disaster Med. 2021 Aug;36(4):426-430. doi: 10.1017/S1049023X2100042X. Epub 2021 May 11.
San Francisco (California USA) is a relatively compact city with a population of 884,000 and nine stroke centers within a 47 square mile area. Emergency Medical Services (EMS) transport distances and times are short and there are currently no Mobile Stroke Units (MSUs).
This study evaluated EMS activation to computed tomography (CT [EMS-CT]) and EMS activation to thrombolysis (EMS-TPA) times for acute stroke in the first two years after implementation of an emergency department (ED) focused, direct EMS-to-CT protocol entitled "Mission Protocol" (MP) at a safety net hospital in San Francisco and compared performance to published reports from MSUs. The EMS times were abstracted from ambulance records. Geometric means were calculated for MP data and pooled means were similarly calculated from published MSU data.
From July 2017 through June 2019, a total of 423 patients with suspected stroke were evaluated under the MP, and 166 of these patients were either ultimately diagnosed with ischemic stroke or were treated as a stroke but later diagnosed as a stroke mimic. The EMS and treatment time data were available for 134 of these patients with 61 patients (45.5%) receiving thrombolysis, with mean EMS-CT and EMS-TPA times of 41 minutes (95% CI, 39-43) and 63 minutes (95% CI, 57-70), respectively. The pooled estimates for MSUs suggested a mean EMS-CT time of 35 minutes (95% CI, 27-45) and a mean EMS-TPA time of 48 minutes (95% CI, 39-60). The MSUs achieved faster EMS-CT and EMS-TPA times (P <.0001 for each).
In a moderate-sized, urban setting with high population density, MP was able to achieve EMS activation to treatment times for stroke thrombolysis that were approximately 15 minutes slower than the published performance of MSUs.
旧金山（美国加利福尼亚州）是一个相对紧凑的城市，人口 88.4 万，在 47 平方英里的范围内有 9 个中风中心。紧急医疗服务（EMS）的转运距离和时间都很短，目前没有移动卒中单元（MSU）。
本研究评估了在旧金山一家医疗保障医院实施急诊科（ED）为中心、直接将 EMS 转运至 CT（EMS-CT）的“任务方案”（MP）后的头两年内，急性卒中患者的 EMS 激活至 CT（EMS-CT）时间和 EMS 激活至溶栓（EMS-TPA）时间，并将其表现与来自 MSU 的已发表报告进行比较。EMS 时间是从救护车记录中提取的。MP 数据的几何平均值和从已发表的 MSU 数据中汇总的平均值均采用相同的方法进行计算。
2017 年 7 月至 2019 年 6 月，共有 423 名疑似卒中的患者在 MP 下进行了评估，其中 166 名患者最终被诊断为缺血性卒中，或被诊断为卒中但后来被诊断为卒中模拟症。这些患者中有 134 名患者的 EMS 和治疗时间数据可用，其中 61 名患者（45.5%）接受了溶栓治疗，其 EMS-CT 和 EMS-TPA 的平均时间分别为 41 分钟（95%CI，39-43）和 63 分钟（95%CI，57-70）。MSU 的汇总估计值表明，EMS-CT 的平均时间为 35 分钟（95%CI，27-45），EMS-TPA 的平均时间为 48 分钟（95%CI，39-60）。MSU 实现了更快的 EMS-CT 和 EMS-TPA 时间（每种方法均 P <.0001）。
在人口密度较高的中等规模城市环境中，MP 实现的卒中溶栓治疗的 EMS 激活至治疗时间比已发表的 MSU 性能慢约 15 分钟。
