title: Fire Engine Support and On-scene Time in Prehospital Stroke Care - A Prospective Observational Study.
abstract: Introduction On-scene time (OST) previously has been shown to be a significant component of Emergency Medical Services' (EMS') operational delay in acute stroke. Since stroke patients are managed routinely by two-person ambulance crews, increasing the number of personnel available on the scene is a possible method to improve their performance. Hypothesis Using fire engine crews to support ambulances on the scene in acute stroke is hypothesized to be associated with a shorter OST.
  
  
  METHODS
  All patients transported to hospital as thrombolysis candidates during a one-year study period were registered by the ambulance crews using a case report form that included patient characteristics and operational EMS data.
  
  
  RESULTS
  Seventy-seven patients (41 [53%] male; mean age of 68.9 years [SD=15]; mean Glasgow Coma Score [GCS] of 15 points [IQR=14-15]) were eligible for the study. Forty-five cases were managed by ambulance and fire engine crews together and 32 by the ambulance crews alone. The median ambulance response time was seven minutes (IQR=5-10) and the fire engine response time was six minutes (IQR=5-8). The number of EMS personnel on the scene was six (IQR=5-7) and two (IQR=2-2), and the OST was 21 minutes (IQR=18-26) and 24 minutes (IQR=20-32; P =.073) for the groups, respectively. In a following regression analysis, using stroke as the dispatch code was the only variable associated with short (<22 minutes) OST with an odds ratio of 3.952 (95% CI, 1.279-12.207).
  
  
  CONCLUSIONS
  Dispatching fire engine crews to support ambulances in acute stroke care was not associated with a shorter on-scene stay when compared to standard management by two-person ambulance crews alone. Using stroke as the dispatch code was the only variable that was associated independently with a short OST. Puolakka T , Väyrynen T , Erkkilä E-P , Kuisma M . Fire engine support and on-scene time in prehospital stroke care - a prospective observational study. Prehosp Disaster Med. 2016;31(3):278-281.
authors.affiliation: 1Section of Emergency Medical Services,Department of Emergency Medicine,Helsinki University Hospital and University of Helsinki,Helsinki,Finland.
authors.forename: Tuukka
authors.initials: T
authors.lastname: Puolakka
authors.affiliation: 1Section of Emergency Medical Services,Department of Emergency Medicine,Helsinki University Hospital and University of Helsinki,Helsinki,Finland.
authors.forename: Taneli
authors.initials: T
authors.lastname: Väyrynen
authors.affiliation: 3Tampere Area Rescue Department,City of Tampere,Finland.
authors.forename: Elja-Pekka
authors.initials: EP
authors.lastname: Erkkilä
authors.affiliation: 1Section of Emergency Medical Services,Department of Emergency Medicine,Helsinki University Hospital and University of Helsinki,Helsinki,Finland.
authors.forename: Markku
authors.initials: M
authors.lastname: Kuisma
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances / Q000458:organization & administration; D017598:Efficiency, Organizational; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000628:therapy*; D013997:Time Factors
keywords: EMS Emergency Medical Services; Emergency Medical Services; GCS Glasgow Coma Score; OST on-scene time; stroke; time factors