title: [Impact of mobile intensive care units on treating stroke within the 3-hour time window in a semi-rural area].
abstract: OBJECTIVE
  We tested the hypothesis that calling emergency medical services ("15", French equivalent of 911 or 999 calls) and response by a mobile intensive care unit staffed by emergency physicians (MICU) reduces the time to treatment to within the 3-hour time window required for administration of recombinant tissue plasminogen activator.
  
  
  METHODS
  This study compared the time from symptom onset to admission (prehospital time), from admission to treatment (imaging and treatment delays, hospital time), and total time from symptom onset to treatment in an observational cohort of 53 consecutive patients, according to how they reached the hospital (Group 1: MICU and group 2: standard emergency ambulance dispatched by EMS center [2a] or direct admission [2b]).
  
  
  RESULTS
  The study included 52 patients (1 was excluded because hospitalized at the time of the stroke): 27 (51.9%) in group 1, 16 (30.8%) in group 2a, and 9 (17.3%) in group 2b. Calling "15" shortened total home-to-needle time by 24 minutes (p=0.034). The mean total time was not significantly shorter in group 1 (152 versus 162 min; p=0.27) but MICUs were used for patients farther away (mean distance 25 versus 11 km; p=0.02). The average prehospital time was thus higher in group 1 (86 versus 69 min; p=0.044), but was compensated by a reduction in the average hospital time (66 versus 93 min; p=0.0001), due mainly to shorter waits for imaging (22 versus 45 min; p=0.0001).
  
  
  CONCLUSIONS
  Calling the emergency services number reduces mean total time. MICUs were associated with a longer prehospital time, mainly due to greater distances, but they facilitated in-hospital management.
authors: Service de neurologie, Hôpital Saint-Jean, F-66046 Perpignan Cedex, France. denis.sablot@ch-perpignan.fr
authors: Denis
authors: D
authors: Sablot
authors: Mathieu
authors: M
authors: Magnaudeix
authors: Aziz
authors: A
authors: Akouz
authors: Jany
authors: J
authors: Rey
authors: Christophe
authors: C
authors: De la Vega
authors: Jean-Christophe
authors: JC
authors: Blenet
authors: Laurent
authors: L
authors: Ortega
authors: Jean-Francois
authors: JF
authors: Cassarini
authors: Gwanaele
authors: G
authors: Runavot
authors: Diane
authors: D
authors: Cerutti
authors: Ruxandra
authors: R
authors: Filipov
authors: Yves
authors: Y
authors: Garcia
authors: Michel
authors: M
authors: Mora
authors: Jean-Emmanuel
authors: JE
authors: De la Coussaye
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology; D003952:Diagnostic Imaging; D004632:Emergency Medical Services; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005602:France / Q000453:epidemiology; D006801:Humans; D007267:Injections; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D008952:Mobile Health Units; D019035:Rural Health Services; D020521:Stroke / Q000188:drug therapy*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator