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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
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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?
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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
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What tools does the EMT have?
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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.
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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.
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9% of all LVOs had NIH ≤4 Dirty Secret
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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
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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
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Predicting the best outcome
Courtesy of Korilyn Sauser Zachrison, MD Predicting the best outcome
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Other opportunities iTreat MayoClinic
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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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