JEMS : a journal of emergency medical services
-
We collected EMS-reported "last known normal" (LKN) times for patients brought to the ED with suspected acute stroke and calculated the absolute difference between the neurologist-determined and EMS-reported LKN times (deltaLKN). We determined the rate of inappropriate IV tissue plasminogen activator (tPA) use if the EMS-reported times were used instead of the neurologist-determined times. Of 251 patients, mean and median deltaLKN were 28 and 0 minutes, respectively. deltaLKN was < 15 minutes in 91% of the entire group and < 15 minutes in 80% of patients with a diagnosis of stroke. ⋯ Conversely, of patients who didn't receive IV tPA, 6% would have been incorrectly included for IV tPA consideration had the EMS time been used. In patients with wake-up stroke symptoms, EMS underestimated LKN times by an average of 208 minutes. All of the potentially incorrectly included patients would've been wake-up strokes.
-
If you've been working in EMS for much more than a week, the title of this column probably evoked some sort of visceral response from you--and not a positive one. The phrase "Mother, may I...?" has long been attached to EMS systems that require EMTs and paramedics to call their base hospitals prior to performing most interventions or delivering medications. Where the rub comes in is that most field people I know would prefer a little more leeway, something like a "Mother, I'm going out now" type of system.