Abstract WP52: Emergency Medical Services Documentation Of Stroke Care In The United States

Introduction: Emergency medical services (EMS) are often the first point of medical contact for patients suffering from acute stroke. EMS must identify and triage patients appropriately for them to receive the best care. Several prehospital stroke scales exist to assist prehospital providers in identifying acute stroke in the field, but their real-world applications are poorly characterized. Understanding prehospital stroke treatment provides the opportunity to identify areas of improvement across the stroke continuum of care. Methods: We retrospectively reviewed data from the 2019 National EMS Information System (NEMSIS) dataset from the United States of America. NEMSIS contains standardized information reported by states on EMS activations. Observations included were transported by ground ambulance and had an EMS provider documented stroke assessment with a primary impression of stroke or TIA. Observations excluded interfacility transfers and were limited to activations that documented pre-notification of hospital-based stroke specialty team resources. Results: EMS providers used a variety of stroke scales in 2019. Of 30,436 observations, the Cincinnati Prehospital Stroke Scale was the most common with 17,462 uses (57.37%). The F.A.S.T. Exam came second with 3366 (11.05%) uses and the Los Angeles Prehospital Stroke Scale with 3,146 (10.33%). EMS providers recorded “Other Stroke Scale Type” 4362 (14.33%) times. EMS providers documented either a negative or inconclusive stroke score 10,390 (34.13%) times. EMS documented stroke specialty team notifications 17,391 (57.14%) of the time. EMS did not pre-notify the stroke specialty team for 13,045 (42.86%) of patients. 3,576 (27.41%) of these patients received a negative stroke scale score, 1,745 (13.38%) inconclusive and 7,724 (59.21%) positive respectively. Among cases where EMS notified a stroke specialty team 1,590 (9.14%) received a negative, 2,479 (14.25%) an inconclusive and 13,322 (76.60%) a positive stroke scale score. Conclusion: US EMS stroke care documentation has substantial variability and is ripe for standardization. This fact necessitates research to understand its causes and achieve pre-hospital stroke care optimization on a national scale.