title: Stroke care: initial data from a county-based bypass protocol for patients with acute stroke.
abstract: BACKGROUND
  Early identification and transfer of patients with acute stroke to a primary or comprehensive stroke center results in favorable outcomes.
  
  
  OBJECTIVE
  To describe implementation and results of an emergency medical service (EMS)-driven stroke protocol in Lucas County, Ohio.
  
  
  METHODS
  All county EMS personnel (N=464) underwent training in theRapidArterial oCclusionEvaluation (RACE) score. The RACE Alert (RA) protocol, whereby patients with stroke and a RACE score ≥5 were taken to a facility that offered advanced therapy, was implemented in July 2015. During the 6-month study period, 109 RAs were activated. Time efficiencies, diagnostic accuracy, and mechanical thrombectomy (MT) outcomes were compared with standard 'stroke-alert' (N=142) patients from the preceding 6 months.
  
  
  RESULTS
  An increased treatment rate (25.6% vs 12.6%, p<0.05) and improved time efficiency (median door-to-CT 10 vs 28 min, p<0.05; door-to-needle 46 vs 75 min, p<0.05) of IV tissue plasminogen activator within the RA cohort was achieved. The rate of MT (20.1% vs 7.7%, p=0.06) increased and treatment times improved, including median arrival-to-puncture (68 vs 128 min, p=0.04) and arrival-to-recanalization times (101 vs 205 min, p=0.001) in favor of the RA cohort. A non-significant trend towards improved outcome (50% vs 36.4%, p=0.3) in the RA cohort was noted. The RA protocol also showed improved diagnostic specificity for ischemic stroke (52.3% vs 30.1%, p<0.05).
  
  
  CONCLUSIONS
  Our results indicate that EMS adaptation of the RA protocol within Lucas County is feasible and effective for early triage and treatment of patients with stroke. Using this protocol, we can significantly improve treatment times for both systemic thrombolysis and MT.
authors.affiliation: Department of Neurology, University of Toledo Medical Center, Toledo, Ohio, USA.
authors.forename: Syed F
authors.initials: SF
authors.lastname: Zaidi
authors.affiliation: Promedica Toledo Hospital, Toledo, Ohio, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Shawver
authors.affiliation: Department of Neurology, University of Toledo Medical Center, Toledo, Ohio, USA.
authors.forename: Aixa
authors.initials: A
authors.lastname: Espinosa Morales
authors.affiliation: Department of Neurology, University of Toledo Medical Center, Toledo, Ohio, USA.
authors.forename: Hisham
authors.initials: H
authors.lastname: Salahuddin
authors.affiliation: Department of Neurology, University of Toledo Medical Center, Toledo, Ohio, USA.
authors.forename: Gretchen
authors.initials: G
authors.lastname: Tietjen
authors.affiliation: Promedica Toledo Hospital, Toledo, Ohio, USA.
authors.forename: David
authors.initials: D
authors.lastname: Lindstrom
authors.affiliation: Lucas County EMS, Toledo, Ohio, USA.
authors.forename: Brent
authors.initials: B
authors.lastname: Parquette
authors.affiliation: Mercy St Vincent Hospital Toledo, Toledo, Ohio, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Adams
authors.affiliation: Department of Neurology, University of Toledo Medical Center, Toledo, Ohio, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Korsnack
authors.affiliation: Department of Neurology, University of Toledo Medical Center, Toledo, Ohio, USA.
authors.forename: Mouhammad A
authors.initials: MA
authors.lastname: Jumaa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D013223:Statistics as Topic / Q000379:methods; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D017131:Thrombectomy / Q000379:methods*; D015912:Thrombolytic Therapy / Q000379:methods*; D061665:Time-to-Treatment; D014057:Tomography, X-Ray Computed; D014218:Triage / Q000379:methods
keywords: Standards; Stroke