Cutting the Prehospital On-Scene Time of Stroke Thrombolysis in Helsinki: A Prospective Interventional Study.
Significant portion of the prehospital delay consists of minutes spent on the scene with the patient. We implemented a training program for the emergency medical services personnel with the aim to optimize the on-scene time (OST) and to study the impact of different elements of prehospital practice to the OST duration.



In this prospective interventional study, key operational emergency medical service performance variables were analyzed from all thrombolysis candidates transported to the Helsinki University Hospital emergency department. The catchment period was 4 months before and 4 months after the implementation.



One hundred and forty-one patients were managed as thrombolysis candidates before and 148 patients after the training program implementation. The OST duration for the groups was 25 (20.5-31) and 22.5 (18-28.5) minutes, respectively (P<0.001). Physician consultations via telephone were associated with a longer (odds ratio 0.546 [0.333-0.893]) and advanced life support training with a shorter OST (odds ration 1.760 [1.070-2.895]).



Implementation of the emergency medical services training program successfully decreased the OST of thrombolysis candidates by 10%. Higher expertise level of the ambulance crew was associated with shorter OST, and decisions to consult a physician via telephone were reflected by longer OST.
From the Emergency Medicine and Services (T.P., M.K., S.L., J.P., J.H.), Clinical Neurosciences and Neurology (K.R., P.J.L.), and Research Programs Unit, Molecular Neurology (P.J.L.), Helsinki University Hospital, University of Helsinki, Finland. tuukka.puolakka@hus.fi.
Tuukka
T
Puolakka
From the Emergency Medicine and Services (T.P., M.K., S.L., J.P., J.H.), Clinical Neurosciences and Neurology (K.R., P.J.L.), and Research Programs Unit, Molecular Neurology (P.J.L.), Helsinki University Hospital, University of Helsinki, Finland.
Markku
M
Kuisma
From the Emergency Medicine and Services (T.P., M.K., S.L., J.P., J.H.), Clinical Neurosciences and Neurology (K.R., P.J.L.), and Research Programs Unit, Molecular Neurology (P.J.L.), Helsinki University Hospital, University of Helsinki, Finland.
Sami
S
Länkimäki
From the Emergency Medicine and Services (T.P., M.K., S.L., J.P., J.H.), Clinical Neurosciences and Neurology (K.R., P.J.L.), and Research Programs Unit, Molecular Neurology (P.J.L.), Helsinki University Hospital, University of Helsinki, Finland.
Jyrki
J
Puolakka
From the Emergency Medicine and Services (T.P., M.K., S.L., J.P., J.H.), Clinical Neurosciences and Neurology (K.R., P.J.L.), and Research Programs Unit, Molecular Neurology (P.J.L.), Helsinki University Hospital, University of Helsinki, Finland.
Juhana
J
Hallikainen
From the Emergency Medicine and Services (T.P., M.K., S.L., J.P., J.H.), Clinical Neurosciences and Neurology (K.R., P.J.L.), and Research Programs Unit, Molecular Neurology (P.J.L.), Helsinki University Hospital, University of Helsinki, Finland.
Kirsi
K
Rantanen
From the Emergency Medicine and Services (T.P., M.K., S.L., J.P., J.H.), Clinical Neurosciences and Neurology (K.R., P.J.L.), and Research Programs Unit, Molecular Neurology (P.J.L.), Helsinki University Hospital, University of Helsinki, Finland.
Perttu J
PJ
Lindsberg
D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances / Q000592:standards / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000592:standards* / Q000706:statistics & numerical data; D004634:Emergency Medical Technicians / Q000193:education / Q000592:standards* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D005387:Finland; D006801:Humans; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D011446:Prospective Studies; D020521:Stroke; D015912:Thrombolytic Therapy / Q000592:standards* / Q000706:statistics & numerical data; D013997:Time Factors
ambulance; attention; emergency medical services; expedition; stroke