Paramedics– San Diego Experience

Background. Prehospital personnel in Emergency Medical Service (EMS) systems have varying levels of accuracy in stroke recognition. Identifying the accuracy of emergency medical dispatcher using Medical Priority Dispatch Systems (MPDS) stroke protocol and paramedics may help understand the accuracy of stroke recognition in about 3000 emergency medical dispatch systems and prehospital systems world wide. Objective. Our aim was to assess the accuracy of stroke identification in emergency medical dispatchers (EMD) with high compliance to MPDS protocol and paramedics using Cincinnati Prehospital Stroke Scale (CSS). Methods. This was a retrospective observational study. Data was acquired from a computer assisted dispatch (CAD) system, a computerized paramedic record database and discharge diagnosis from billing records or stroke registry containing all stroke assessments of patients who presented to the participating study hospitals within 12 hours of symptom onset. We included patients 18 years or older, identified as having stroke by EMD and city agency paramedics. We excluded patients taken to hospitals not participating in the study, patients with a dispatch determinant of Stroke (card 28) not transported by City EMS agency (SDMSE) to participating hospitals, patients in the stroke registry not transported by SDMSE or patients with no final outcome data. A stroke neurologist or hospital discharge diagnosis of stroke (physician diagnosis) was used to determine the sensitivity and predictive values of EMD and paramedic recognition of stroke. Results. Of 882 patients with a dispatch determinant of stroke using MPDS Stroke protocol, 367 had a final discharge diagnosis of stroke. This gives a sensitivity of 83% and a positive predictive value of 42% for EMD using MPDS Stroke protocol. Of 477 patients with a paramedic Received from the Department of Emergency Medicine, University of San Francisco Medical Center, San Francisco, CA (PR); Department of Emergency Medicine, University of San Diego Medical Center, San Diego, CA (KZG, EMC, JVD); Department of Neurology, University of Wisconsin-Madison, Clinical Science Center, Madison, WI (MC, MBJ); City of San Diego Emergency Medical Services, San Diego, CA (WL, EP, JVD), and Department of Emergency Medicine, Sharp Grossmont Hospital, La Mesa, CA (WL) Support: This study was funded by the Stroke Center, University of California San Diego Medical Center. Conflict of Interests: None of the authors have financial disclosures or conflicts of interest to declare in regards to this study. Address correspondence to Prasanthi Ramanujam MBBS, Department of Emergency Medicine, University of San Francisco Medical Center, 505 Parnassus Avenue L-126, San Francisco, CA 94143–0208. e-mail: [email protected]. doi: 10.1080/10903120802099526 assessment of stroke using CSS, 193 had a final discharge diagnosis of stroke. This gives a sensitivity of 44% and a PPV of 40% for paramedics using CSS. Conclusions. In our EMS system, EMD using MPDS Stroke protocol with a high compliance has a higher sensitivity than paramedics using CSS.