Patel Krish, Konda Sanjana, Ganti Latha, Banerjee Anjali, Banerjee Paul
Council Rock School District, Newton, PA, 18940, USA.
Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA.
Int J Emerg Med. 2024 Oct 8;17(1):146. doi: 10.1186/s12245-024-00722-1.
The subarachnoid space in the brain contains crucial blood vessels and cerebrospinal fluid. Aneurysms in these vessels can lead to subarachnoid hemorrhage (SAH), a serious stroke subtype with high morbidity and mortality rates. SAH treatment includes procedures like coiling and clipping, but these are available only at comprehensive stroke centers (CSCs), necessitating urgent diagnosis and transfer to specialized facilities.
This IRB-approved study was conducted by Polk County Fire Rescue (PCFR) in Florida. PCFR, serving an 850,000-person population, implemented a three-step SAH protocol. The protocol uses both Ottawa SAH criteria and recurring symptoms, such as new-onset seizures and high systolic blood pressure, that were identified by EMS. Acute management included administering labetalol, levetiracetam, and ondansetron.
Of 2175 stroke patients, 80 screened positive for SAH and were eligible for transfer. Patients had a median age of 66, and 33% had an initial systolic BP over 220 mmHg. The interfacility transfer rate dropped from 12.9 to 3.6% after implementing the protocol.
The PCFR protocol's effectiveness suggests its potential for nationwide implementation. Early SAH recognition and prompt transfer to CSCs reduce complications and improve outcomes. Accurate field diagnosis by EMTs can prevent unnecessary transfers and enhance patient care. Future improvements may include portable diagnostic tools and enhanced EMT training to further improve SAH patients' pre-hospital care.
脑蛛网膜下腔包含重要血管和脑脊液。这些血管中的动脉瘤可导致蛛网膜下腔出血（SAH），这是一种严重的中风亚型，发病率和死亡率都很高。SAH的治疗方法包括栓塞和夹闭等手术，但这些手术仅在综合性卒中中心（CSC）才有，因此需要紧急诊断并转至专科医院。
这项经机构审查委员会批准的研究由佛罗里达州的波尔克县消防救援局（PCFR）开展。PCFR服务于85万人口，实施了三步SAH方案。该方案同时采用渥太华SAH标准以及由急救医疗服务（EMS）识别出的复发症状，如新发癫痫和高收缩压。急性处理措施包括给予拉贝洛尔、左乙拉西坦和昂丹司琼。
在2175名中风患者中，80人SAH筛查呈阳性且符合转院条件。患者的年龄中位数为66岁，33%的患者初始收缩压超过220 mmHg。实施该方案后，机构间转院率从12.9%降至3.6%。
PCFR方案的有效性表明其有在全国实施的潜力。早期识别SAH并迅速转至CSC可减少并发症并改善预后。急救医疗技术人员（EMT）进行准确的现场诊断可避免不必要的转院并提升患者护理水平。未来的改进措施可能包括便携式诊断工具以及强化EMT培训，以进一步改善SAH患者的院前护理。
