Management of possible stroke by laypeople in pre-hospital setting: who should we train?

Management of possible stroke by laypeople in pre-hospital setting: who should we train?

Authors

  • Giuseppe Stirparo Faculty of Medicine, School of Public Health – Università Vita-Salute San Raffaele, 20132 Milan, Italy
  • Erika Kacerik Faculty of Medicine, School of Public Health – Università Vita-Salute San Raffaele, 20132 Milan, Italy
  • Giuseppe Ristagno Department of Fisiopatologia Medico-Chirurgica e dei Trapianti – Università degli Studi di Milano, 20122 Milan
  • Aida Andreassi Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ)
  • Anna Coppo Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ)
  • Maurizio Migliari Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ)
  • Andrea Albonico Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ)
  • Giuseppe Maria Sechi Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ)
  • Alberto Zoli Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ)
  • Carlo Signorelli Faculty of Medicine, School of Public Health – Università Vita-Salute San Raffaele, 20132 Milan, Italy

Keywords:

emergency care pre-hospital, emergency medical services, Italy, stroke, training

Abstract

Background and aim: The pre-hospital management of a possible stroke is fundamental for the transport of patients to the correct HUB facility; thus, they must be transported to the Emergency Department (ED) by EMS vehicles. Our study aims to analyze the factors correlated with a higher probability of accessing the ED through the EMS in this event.

Methods: This is a retrospective observational study. All accesses in the 120 EDs of the Lombardy region, with a diagnosis of discharge whose symptoms could resemble CPSS, were analyzed between 1 January 2019 and 31 December 2019.

Results: We identified an increased probability of using the EMS vehicles of 0,05% (I.C. 95%: 0.04% - 0.06%; p<0.0001) for each additional year of age, considering patients aged 20 to 100 years and the percentage was significantly higher in the female population (58% vs 49%; p<0.001). Moreover, we calculated that the incidence of stroke was approximately 140 cases per 100,000 inhabitants.

Conclusions: Only half of the citizens in the Lombardy region use the EMS in case of suspicion of stroke; further information campaigns are essential to educate citizens. Information strategies should be directed especially at men between 30 and 59 years old.

Author Biographies

Giuseppe Stirparo, Faculty of Medicine, School of Public Health – Università Vita-Salute San Raffaele, 20132 Milan, Italy

Second affiliation:

Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ)

Giuseppe Ristagno , Department of Fisiopatologia Medico-Chirurgica e dei Trapianti – Università degli Studi di Milano, 20122 Milan

Second affiliation:

Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20090 Milan, Italy

References

Signorelli C, Odone A, Stirparo G, et al. SARS-CoV-2 transmission in the Lombardy Region: the increase of household contagion and its implication for containment measures. Acta Biomed. 2020 Nov 20;91(4):e2020195. doi: 10.23750/abm.v91i4.10994.

Stirparo G, Oradini-Alacreu A, et al. Public health impact of the COVID-19 pandemic on the emergency healthcare system. J Public Health (Oxf). 2022 Mar 7;44(1):e149-e152. doi: 10.1093/pubmed/fdab212.

tirparo, G., Oradini-Alacreu, A., Signorelli, C. et al. Smart-working policies during COVID-19 pandemic: a way to reduce work-related traumas? Intern Emerg Med 17, 2427–2430 (2022). doi: 10.1007/s11739-022-03076-9.

Stirparo G, Fagoni N, Bellini L, et al. Cardiopulmonary resuscitation missed by bystanders: Collateral damage of coronavirus disease 2019. Acta Anaesthesiol Scand. 2022 Oct;66(9):1124-1129. doi: 10.1111/aas.14117.

Stirparo G, Bellini L, Ristagno G, et al. The Impact of COVID-19 on Lombardy Region ST-Elevation Myocardial Infarction Emergency Medical System Network-A Three-Year Study. J Clin Med. 2022 Sep 27;11(19):5718. doi: 10.3390/jcm11195718.

Fagoni N, Perone G, Villa GF, et al. The Lombardy emergency medical system faced with COVID-19: the impact of out-of-hospital outbreak. Prehosp Emerg Care. 2021 Jan-Feb;25(1):1-7. doi: 10.1080/10903127.2020.1824051.

Stirparo G, Ristagno G, Bellini L, et al. Changes to the major trauma pre-hospital emergency medical system network before and during the 2019 COVID-19 pandemic. J Clin Med 2022, 11, 6748. doi: 10.3390/jcm11226748.

Pezzini A, Grassi M, Silvestrelli G, et al. Impact of SARS-CoV-2 on reperfusion therapies for acute ischemic stroke in Lombardy, Italy: the STROKOVID network. J Neurol. 2021 Oct;268(10):3561-3568. doi: 10.1007/s00415-021-10497-7.

Asteggiano F, Divenuto I, Ajello D, et al. Stroke management during the COVID-19 outbreak: challenges and results of a hub-center in Lombardy, Italy. Neuroradiology. 2021 Jul;63(7):1087-1091. doi: 10.1007/s00234-020-02617-3.

Worster A, Chan T. Evidence-based emergency medicine. Does this patient have a hemorrhagic stroke? Ann Emerg Med. 2011 May;57(5):535-6. doi: 10.1016/j.annemergmed.2010.08.023.

Heemskerk JL, Domingo RA, Tawk RG, et al. Time is brain: prehospital emergency medical services response times for suspected stroke and effects of prehospital interventions. Mayo Clin Proc. 2021 Jun;96(6):1446-1457. doi: 10.1016/j.mayocp.2020.08.050.

Viereck S, Møller TP, Iversen HK, Christensen H, Lippert F. Medical dispatchers recognise substantial amount of acute stroke during emergency calls. Scand J Trauma Resusc Emerg Med. 2016 Jul 7;24:89. doi: 10.1186/s13049-016-0277-5.

Vidale S, Agostoni E. Prehospital stroke scales and large vessel occlusion: A systematic review. Acta Neurol Scand. 2018 Jul;138(1):24-31. doi: 10.1111/ane.12908.

Vidale S, Arnaboldi M, Frangi L, Longoni M, Monza G, Agostoni E. The Large ARtery Intracranial Occlusion Stroke Scale: A New Tool With High Accuracy in Predicting Large Vessel Occlusion. Front Neurol. 2019 Feb 19;10:130. doi: 10.3389/fneur.2019.00130.

Schuberg S, Song S, Saver JL, Mack WJ, Cen SY, Sanossian N. Impact of emergency medical services stroke routing protocols on Primary Stroke Center certification in California. Stroke. 2013 Dec;44(12):3584-6. doi: 10.1161/STROKEAHA.113.000940.

Katz BS, McMullan JT, Sucharew H, Adeoye O, Broderick JP. Design and validation of a prehospital scale to predict stroke severity. Stroke. 2015 Jun 4;46(6):1508–12. doi:10.1161/STROKEAHA.115.008804.

De Luca A, Giorgi Rossi P, Villa GF. Stroke group Italian Society pre hospital emergency Services. The use of Cincinnati Prehospital Stroke Scale during telephone dispatch interview increases the accuracy in identifying stroke and transient ischemic attack symptoms. BMC Health Serv Res. 2013 Dec 11;13:513. doi: 10.1186/1472-6963-13-513.

Alper BS, Foster G, Thabane L, Rae-Grant A, Malone-Moses M, Manheimer E. Thrombolysis with alteplase 3-4.5 hours after acute ischaemic stroke: trial reanalysis adjusted for baseline imbalances. BMJ Evid Based Med. 2020 Oct;25(5):168-171. doi: 10.1136/bmjebm-2020-111386.

Sturla MI, Kacerik E, Andreassi A, et al. Out of hospital cardiac arrest in sporting facilities: an overview of rescue for sideline doctors. Med Sport 2023;76:70-8. doi: 10.23736/ S0025-7826.23.04231-X.

Stirparo G, Andreassi A, Sechi GM, Signorelli C. Spring, it’s time to ROSC. J Prev Med Hyg 2023; 64:E87‐E91. doi: 10.15167/2421-4248/jpmh2023.64.1.2782.

Davis NW, Bailey M, Buchwald N, Farooqui A, Khanna A. Factors that influence door-to-needle administration for acute stroke patients in the emergency department. J Neurosci Nurs. 2021 Jun 1;53(3):134-139. doi: 10.1097/JNN.0000000000000590.

Jauch EC, Huang DY, Gardner AJ, Blum JL. Strategies for improving outcomes in the acute management of ischemic stroke in rural emergency departments: a quality improvement initiative in the Stroke Belt. Open Access Emerg Med. 2018;10:53–9. doi: 10.2147/OAEM.S160269.

Eswaradass PV, Swartz RH, Rosen J, Hill MD, Lindsay MP. Access to hyperacute stroke services across Canadian provinces: a geospatial analysis. CMAJ Open. 2017 Jun 14;5(2):E454-E459. doi: 10.9778/cmajo.20160166.

Powers WJ, Rabinstein AA, Ackerson T, et al. 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018 Mar 1;49(3):e46–110. doi: 10.1161/STR.0000000000000158.

Fussman C, Rafferty AP, Lyon-Callo S, Morgenstern LB, Reeves MJ. Lack of association between stroke symptoms knowledge and intent to call 911. Stroke. 2010 Jul;41(7):1501–7. doi: 10.1161/STROKEAHA.110.578195.

Silver FL, Rubini F, Black D, Hodgson CS. Advertising strategies to increase public awareness of the warning signs of stroke. Stroke. 2003 Aug 1;34(8):1965–8. doi: 10.1161/01.STR.0000083175.01126.62.

Mellon L, Hickey A, Doyle F, Dolan E, Williams D. Can a media campaign change health service use in a population with stroke symptoms? Examination of the first Irish stroke awareness campaign. Emerg Med J. 2014 Jul;31(7):536-540. doi: 10.1136/emermed-2012-202280.

Kwan J, Hand P, Sandercock P. A systematic review of barriers to delivery of thrombolysis for acute stroke. Age Ageing. 2004 Mar;33(2):116-21. doi: 10.1093/ageing/afh064.

Meurer WJ, Levine DA, Kerber KA, et al. Neighborhood influences on emergency medical services use for acute stroke: a population-based cross-sectional study. Ann Emerg Med. 2016 Mar 1;67(3):341-348.e4. doi: 10.1016/j.annemergmed.2015.07.524.

Stirparo G, Gambolò L, Bellini L, et al. Satisfaction evaluation for ACLS training. Acta Biomed. 2022 Jul 1;93(3):e2022260. doi: 10.23750/abm.v93i3.13337.

Giuseppe S, Bellini L, Fagoni N, et al. Missed training, collateral damage from COVID 19? Disaster Med Public Health Prep. 2022 Jan 10:1-8. doi: 10.1017/dmp.2022.14.

Stirparo G, Pireddu R, Kacerik E, et al. Stroke and the need for immediate assistance at the place of onset: the future of mandatory training for lay people in Italy. Ann Ig. 2022 Dec 15. doi: 10.7416/ai.2022.2553.

Downloads

Published

17-10-2023

Issue

Section

ORIGINAL CLINICAL RESEARCH

How to Cite

1.
Stirparo G, Kacerik E, Ristagno G, Andreassi A, Coppo A, Migliari M, et al. Management of possible stroke by laypeople in pre-hospital setting: who should we train?. Acta Biomed [Internet]. 2023 Oct. 17 [cited 2024 Jul. 17];94(5):e2023203. Available from: https://mattioli1885journals.com/index.php/actabiomedica/article/view/14261