Feasibility of neuroprotective agent administration by prehospital personnel in an urban setting.
OBJECTIVE
Studies have demonstrated the importance of early stroke treatment. If a neuroprotective agent (NA) clinical trial is successful, the greatest benefit might be attained with early prehospital administration. This study determined the potential reduction in time to treatment of stroke patients when NAs were administered in the prehospital setting.


METHODS
Twenty-three urban emergency medical services (EMS) agencies participated in this study. Prehospital personnel completed a stroke assessment checklist on any potential stroke victim. The checklist collected clinical inclusion/exclusion criteria for NA administration and event/decision times. Patients meeting the hypothetical clinical inclusion criteria were enrolled into this study. Time data included scene arrival/departure, emergency department (ED) arrival, and estimated time of theoretical NA administration. The reduction in time to stroke treatment was calculated as the difference between the time of ED arrival and the reported time of NA administration. The t test and simple linear regression were used to probe for differences in treatment time reduction between selected subgroups. EMS personnel's ability to obtain informed consent for theoretical NA administration was calculated.


RESULTS
Two hundred twenty-two patients were enrolled in this study; of these, 75 were deemed eligible for hypothetical NA administration and had complete time data. On average, EMS personnel documented the theoretical time of NA administration at 12.04+/-2.07 minutes before arrival at the ED (17.06+/-1.74 minutes when the NA was given on scene [n=43]; 6.65+/-1.14 minutes when the NA was given en route [n=32]).


CONCLUSIONS
Prehospital NA administration can potentially significantly reduce the time to first intervention in stroke patients.
Crocco
Todd
T
Department of Emergency Medicine, West Virginia University, Morgantown, WV 26506-9149, USA. tcrocco@hsc.wvu.edu
Gullett
Travis
T
Davis
Stephen M
SM
Flores
Nicole
N
Sauerbeck
Laura
L
Jauch
Edward
E
Threlkeld
Billie
B
Pio
Brian
B
Ottaway
Michael
M
Pancioli
Arthur
A
Chenier
Thomas
T
D000368:Aged; D000465:Algorithms; D004632:Emergency Medical Services / Q000592:standards / Q000706:statistics & numerical data*; D004634:Emergency Medical Technicians; D005240:Feasibility Studies; D005260:Female; D006302:Health Services Research; D006801:Humans; D007258:Informed Consent; D008297:Male; D018696:Neuroprotective Agents / Q000008:administration & dosage*; D020521:Stroke / Q000188:drug therapy*; D013996:Time and Motion Studies; D014187:Transportation of Patients / Q000706:statistics & numerical data; D019037:Urban Health Services / Q000592:standards / Q000706:statistics & numerical data*
D018696:Neuroprotective Agents