The Emergency Medical Services Impact on Stroke Patient Management Arriving at the Cleveland Clinic Florida (P2.314)

Objective: To evaluate the Emergency Medical Services (EMS) impact on the management of stroke patients in the Cleveland Clinic Florida. Background: Rapid administration of intravenous thrombolysis in patients with acute ischemic stroke requires a well-coordinated process. EMS carries the important role of transporting stroke patients to the ED for rapid intervention. The American Heart Association reduced the goal of door to needle time from 60 to 45 minutes (min). Methods: Single center retrospective chart review of our stroke database from May 2013 to April 2015 in the Cleveland Clinic Florida. Stroke patients were divided in two groups, EMS-arrival group (EMSg) and the ED-walking group (ED-Wg). We assessed demographic data, NIHSS, and the time in minutes (min) for onset to door (OTD-time), door to neurologist (DTN-time), door to computed tomography of the head (DTCT-time), and door to needle (DTN-time) and onset to needle (OTN-time). Results: 62 patients (34 in the EMSg and 28 in the ED-Wg) were included. The mean NIHSS for EMSg and the ED-Wg were 10.0 and 5.1, respectively. An NIHSS of 6 or more was 62[percnt] in the EMSg compare to ED-Wg, 32[percnt]. Mean OTD-time in the EMSg was 163.8 min compare to ED-Wg with 485.6 min. Mean DTN-time is 6.3 min in the EMSg whereas the ED-Wg was 17.5 min. Mean DTCT-time in EMSg was 8 compare to 15.3 min in the ED-Wg. 14 patients received IV-tPA in the EMSg and 8 on the ED-Wg. The mean DTN-time and OTN-time in the EMSg was 41 and 101.6 min compare to 48 and 147.9 min in the ED-Wg. All patients receiving IV-tPA in less than 30 min were in the EMSg. Conclusion: Most patients brought by EMS will have an NIHSS of 6 or more. The EMS is a determining variable to achieve better management in stroke patients. Disclosure: Dr. Reyes has nothing to disclose. Dr. Gonzalez has nothing to disclose. Dr. Riaz has nothing to disclose. Dr. Boddepalli has nothing to disclose. Dr. Mathew has nothing to disclose. Dr. Piran has nothing to disclose. Dr. Linn has nothing to disclose. Dr. Salgado has received personal compensation in an editorial capacity for Belvoir Media Group.