title: Optimized acute stroke pathway using medical advanced regulation for stroke and repeated public awareness campaigns.
abstract: OBJECTIVE
  The aim of this study is to evaluate the efficiency of a specific organizational model for early stroke management associated with repeated public awareness campaigns on stroke warning signs.
  
  
  METHODS
  Our model is based on initial telephone triage of potential candidates for an intravenous thrombolysis by an emergency physician before a 3-party conference including basic life support team on scene and a stroke neurologist. We performed a time series analysis for a period of 5 years and a half, comparing the number of emergency telephone calls with that of intravenous thrombolysis treatment realized.
  
  
  RESULTS
  In our organizational model, repeated awareness public campaigns increased both the number of emergency calls for suspected stroke and the selection of potential candidates for intravenous thrombolysis. Results from the time series analysis suggest that educational campaigns are a major factor influencing our emergency medical service activity. This result is correlated with the number of performed intravenous thrombolyses by the stroke center especially within a 3-hour delay (Spearman ρ, P = .621, P = .000 and P = .439, P = .000, respectively).
  
  
  CONCLUSIONS
  Educational programs repeated each year are useful to the population for learning how to recognize stroke symptoms and send straight away an emergency call. Combining the emergency action with an early remote evaluation by the stroke center team and a direct admission in imaging department shortens the time-to-treatment delay. This model is reproducible in different health care systems.
authors.affiliation: Assistance Publique-Hôpitaux de Marseille, CHU Timone, SAMU 13, 13005 Marseille, France.
authors.forename: Valéry
authors.initials: V
authors.lastname: Soulleihet
authors.affiliation: OLEA Medical, 13600 La Ciotat, France; Assistance Publique-Hôpitaux de Marseille, CHU Timone, Service d'urgences neurovasculaires, 13005 Marseille, France.
authors.forename: François
authors.initials: F
authors.lastname: Nicoli
authors.affiliation: Centre Hospitalier Henri Duffaut, SAMU 84, 84903 Avignon cedex 09, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Trouve
authors.affiliation: Assistance Publique-Hôpitaux de Marseille, CHU Timone, Service de Neuroradiologie, 13005 Marseille, France.
authors.forename: Nadine
authors.initials: N
authors.lastname: Girard
authors.affiliation: Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Accueil des Urgences Médicales, 69003 Lyon, France. Electronic address: laurentjacquin@yahoo.fr.
authors.forename: Laurent
authors.initials: L
authors.lastname: Jacquin
mesh_terms: D000208:Acute Disease; D061605:Administration, Intravenous; D019091:Critical Pathways; D004630:Emergencies; D004631:Emergency Medical Service Communication Systems / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005602:France; D006293:Health Promotion; D006801:Humans; D017146:Models, Organizational; D010348:Patient Care Team; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D014218:Triage / Q000379:methods
chemical_list: D005343:Fibrinolytic Agents