1. Mobile applications are Complementary to Good Clinical EMS Practice and Improve Care
Ethan S. Brandler, MD, MPH, FACEP
Clinical Associate Professor of Emergency Medicine
Associate Director Emergency Medical Services

2. What are we trying to accomplish in the prehospital environment?
ULTIMATE GOAL:
Identify Stroke
Rule out other life threatening diagnoses
Measure Stroke Severity
RACE
FAST-ED
LAMS
NYC S- LAMS
CPSS
Quickly get patients to the place where they are most likely to have the best possible outcome.
What are we trying to accomplish in the prehospital environment?

3. The Problem Complex Decision Multiple Variables
Relies on information that is inaccurate at best
Needs to be accomplished by people with very little training
The Problem

4. What tools does the EMT have?

5. Vascular Neurologist 30 years experience 200 work days/year
4 patients/day
24,000 patients with stroke
Vascular Neurologist
I want to start out by drawing comparisons.

6. Joe EMT 10 years experience 260 work days/ year 8 patients per day
20,800 patients/10 years
208 stroke patients/10 years
52 large vessel occlusions/10 years
Joe EMT
Stroke accounts for 1-2 % of what EMS in NYC sees on a day to day basis.

7. 9% of all LVOs had NIH ≤4
Dirty Secret

8. Variables Time elapsed from last known well Stroke severity
tPA contraindications
In-hospital metrics
Door to Needle Time at Primary Stroke Center
Door to Groin Puncture at Thrombectomy Center
Success rate at thrombectomy center
Travel times
Between Scene and Primary Stroke Center
Between Scene and Thrombectomy Center
Between Centers
Risk factors
Age
Gender
Comorbidities
Variables

9. EMTs and Paramedics Need Help
Needs to be data driven
Based on most current available information
On clinical deficits
On drive times
On door to intervention times
Needs to be about what is best for this patient at this moment.
EMTs and Paramedics Need Help

10. Predicting the best outcome
Courtesy of Korilyn Sauser Zachrison, MD
Predicting the best outcome

11. Other opportunities
iTreat
MayoClinic

12. Other opportunities
Use of Mobile Devices, Social Media, and Crowdsourcing as Digital Strategies to Improve Emergency Cardiovascular Care
A Scientific Statement From the American Heart Association
John S. Rumsfeld, Steven C. Brooks, Tom P. Aufderheide
, Marion Leary, Steven M. Bradley, Chileshe Nkonde-Price, Lee H. Schwamm,Mariell Jessup, Jose Maria E. Ferrer, and Raina M. Merchant and On behalf of the American Heart Association Emergency Cardiovascular Care Committee; Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; Council on Quality of Care and Outcomes Research; Council on Cardiovascular and Stroke Nursing; and Council on Epidemiology and Prevention
Circulation. 2016;134:e87–e108

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