Effects of state-wide implementation of the Los Angeles Motor Scale for triage of stroke patients in clinical practice.

Background: The prehospital identification of stroke patients with large-vessel occlusion (LVO), that should be immediately transported to a thrombectomy capable centre is an unsolved problem. Our aim was to determine whether implementation of a state-wide standard operating procedure (SOP) using the Los Angeles Motor Scale (LAMS) is feasible and enables correct triage of stroke patients to hospitals offering (comprehensive stroke centres, CSCs) or not offering (primary stroke centres, PSCs) thrombectomy.

Methods: Prospective study involving all patients with suspected acute stroke treated in a 4-month period in a state-wide network of all stroke-treating hospitals (eight PSCs and two CSCs).

Prehospital Stroke Management Optimized by Use of Clinical Scoring vs Mobile Stroke Unit for Triage of Patients With Stroke: A Randomized Clinical Trial.

Importance: Transferring patients with large-vessel occlusion (LVO) or intracranial hemorrhage (ICH) to hospitals not providing interventional treatment options is an unresolved medical problem.

Objective: To determine how optimized prehospital management (OPM) based on use of the Los Angeles Motor Scale (LAMS) compares with management in a Mobile Stroke Unit (MSU) in accurately triaging patients to the appropriate hospital with (comprehensive stroke center [CSC]) or without (primary stroke center [PSC]) interventional treatment.

Design, Setting, And Participants: In this randomized multicenter trial with 3-month follow-up, patients were assigned week-wise to one of the pathways between June 15, 2015, and November 15, 2017, in 2 regions of Saarland, Germany; 708 of 824 suspected stroke patients did not meet inclusion criteria, resulting in a study population of 116 adult patients.

[Prehospital management of acute stroke : Using the example of Saarland ambulance services].

Background: The preclinical care strategy was changed after reevaluation of endovascular thrombectomy in the S2k guideline of the German Neurological Society (DGN). Severe strokes should be directly transferred to neurovascular centers (model "mothership"). The severity of a stroke should be determined using the LAMS (Los Angeles Motor Scale) score.

Blood glucose concentrations in prehospital trauma patients with traumatic shock: A retrospective analysis.

Background: Deranged glucose metabolism after moderate to severe trauma with either high or low concentrations of blood glucose is associated with poorer outcome. Data on prehospital blood glucose concentrations and trauma are scarce.

Objectives: The primary aim was to describe the relationship between traumatic shock and prehospital blood glucose concentrations.

Prehospital Computed Tomography Angiography in Acute Stroke Management.

Background: An ambulance equipped with a computed tomography (CT) scanner, a point-of-care laboratory, and telemedicine capabilities (mobile stroke unit [MSU]) has been shown to enable the delivery of thrombolysis to stroke patients directly at the emergency site, thereby significantly decreasing time to treatment. However, work-up in an MSU that includes CT angiography (CTA) may also potentially facilitate triage of patients directly to the appropriate target hospital and specialized treatment, according to their individual vascular pathology.

Methods: Our institution manages a program investigating the prehospital management of patients with suspicion of acute stroke.

'Stroke Room': Diagnosis and Treatment at a Single Location for Rapid Intraarterial Stroke Treatment.

Background: For patients with acute ischemic stroke, intra-arterial treatment (IAT) is considered to be an effective strategy for removing the obstructing clot. Because outcome crucially depends on time to treatment ('time-is-brain' concept), we assessed the effects of an intervention based on performing all the time-sensitive diagnostic and therapeutic procedures at a single location on the delay before intra-arterial stroke treatment.

Methods: Consecutive acute stroke patients with large vessel occlusion who obtained IAT were evaluated before and after implementation (April 26, 2010) of an intervention focused on performing all the diagnostic and therapeutic measures at a single site ('stroke room').

[Significance of Helicopter Emergency Medical Service in Prehospital Trauma Care].

Background: In the late 1960s, the helicopter emergency medical service (HEMS) was established in Germany because of an increasing number of severe injuries in traffic accidents. To get a doctor quickly on scene was the initial intention, rather than transporting the patient. Today, rescue helicopters cover the entire field of emergency medicine and are an important transportation device for polytrauma patients.

EZ-IO(®) intraosseous device implementation in German Helicopter Emergency Medical Service.

Background: Intraosseous access (IO) is a rapid and safe alternative when peripheral venous access is difficult. Our aim was to summarize the first three years experience with the use of a semi-automatic IO device (EZ-IO(®)) in German Helicopter Emergency Medical Service (HEMS).

Methods: Included were all patients during study period (January 2009-December 2011) requiring an IO access performed by HEMS team.

[Improvement of emergency physician education through simulator training. Consideration on the basis of the model project "NASimSaar25"].

Background: Prehospital emergency medicine is a challenge for trainee emergency physicians. Rare injuries and diseases as well as patients in extreme age groups can unexpectedly face emergency physicians. In the regulations on medical education the German Medical Association requires participation in 50 emergency missions under the supervision of an experienced emergency physician.

[Intraosseous infusion in the German Air Rescue Service : Guideline recommendations versus mission reality].

Background: In emergency medicine intraosseous access (IOA) has been established as an alternative to conventional intravenous access. Originally the use of IOA was strictly limited to children up to 6 years of age and to adults for cardiopulmonary resuscitation. These limitations have been relaxed and the indications for IOA have been expanded.

Mobile stroke unit for diagnosis-based triage of persons with suspected stroke.

Background: In this feasibility study, we tested whether prehospital diagnostic stroke workup enables rational decision-making regarding treatment and the target hospital in persons with suspected stroke.

Methods: A mobile stroke unit that delivers imaging (including multimodal brain imaging with CT angiography and CT perfusion), point-of-care-laboratory analysis, and neurologic expertise directly at the emergency site was analyzed for its use in prehospital diagnosis-based triage of suspected stroke patients.

Results: We present 4 complementary cases with suspected stroke who underwent prehospital diagnostic workup that enabled direct diagnosis-based treatment decisions and reliable triage regarding the most appropriate medical facility for that individual, e.

Diagnosis and treatment of patients with stroke in a mobile stroke unit versus in hospital: a randomised controlled trial.

Background: Only 2-5% of patients who have a stroke receive thrombolytic treatment, mainly because of delay in reaching the hospital. We aimed to assess the efficacy of a new approach of diagnosis and treatment starting at the emergency site, rather than after hospital arrival, in reducing delay in stroke therapy.

Methods: We did a randomised single-centre controlled trial to compare the time from alarm (emergency call) to therapy decision between mobile stroke unit (MSU) and hospital intervention.

[Extended medical quality management exemplified by the tracer diagnosis multiple trauma. Pilot study in the air rescue service].

Background: Adequate prehospital and inhospital primary care is a decisive factor in the successful treatment of multiple trauma patients. For optimization of treatment algorithms the implementation of a medical quality management is of utmost importance. The aim of this study was to extend quality management by including data on process quality.

[Use of intraosseus infusion in the German air rescue service : nationwide analysis in the time period 2005 to 2009].

Background: Intraosseous infusion has become established as a fast and safe alternative to conventional vascular access in emergency situations. Originally the use of intraosseous access was limited to children up to 6 years of age and to adults for cardiopulmonary resuscitation but this limitation has now been removed. The aim of this study was to obtain data on mission reality regarding the use of intraosseous access in the prehospital setting against the background of the expanded recommendations on the use of the intraosseous infusion.

Bringing the hospital to the patient: first treatment of stroke patients at the emergency site.

Background: Early treatment with rt-PA is critical for favorable outcome of acute stroke. However, only a very small proportion of stroke patients receive this treatment, as most arrive at hospital too late to be eligible for rt-PA therapy.

Methods And Findings: We developed a "Mobile Stroke Unit", consisting of an ambulance equipped with computed tomography, a point-of-care laboratory system for complete stroke laboratory work-up, and telemedicine capabilities for contact with hospital experts, to achieve delivery of etiology-specific and guideline-adherent stroke treatment at the site of the emergency, well before arrival at the hospital.

[Primary documentation quality for paper-assisted digital mission data documentation. Initial results from the air rescue service].

Background: With the assistance of digital pen and paper technology in the field of prehospital data reporting, it seems to be possible to fulfill the requirements of "documentation" as well as the requirements of "quality management". The aim of this study was to determine the "primary documentation quality" (PDQ) of a data reporting system based on digital pen and paper technology (so-called DINO) within a helicopter emergency medical service (HEMS) over a 6-month period.

Results: The PDQ is defined as the proportion of prehospital documented data, which is primarily recorded correctly by the data reporting system.

[Is there an association between the rating of illness and injury severity and the experience of emergency medical physicians?].

Background: The illness and injury severity of patients in emergency situations is normally rated by the National Advisory Committee for Aeronautics (NACA) score. Different issues seem to limit the validity of the NACA score, therefore, the aim of the present investigation was to analyse the association between rescue experience of pre-hospital emergency physicians and the estimated jeopardy of patients' vital functions using the NACA score.

Material And Methods: In this retrospective study, the emergency chart protocols of patients in a ground-based emergency system from 2004 to 2005 were evaluated concerning patients demographic, diagnosis, and related NACA score.

[Paper-assisted digital Mission documentation in air rescue services. Quality management in preclinical emergency medicine].

Background: Recording of adequate mission data is of utmost importance in prehospital emergency medicine. For this, a nationwide uniform core dataset for prehospital data reporting, the so-called MIND 2, was introduced. With this procedure adequate information about structure and outcome quality, but only little information about process quality, can be obtained.

[Prognostic value of routine parameters and laboratory parameters after major trauma. A prospective preclinical-clinical study of air rescue patients].

In this prospective study, 273 air rescue patients with major blunt trauma were followed throughout their prehospital and clinical management. A blood sample was taken upon arrival and data acquired at three defined time points. With these data, for the first time a prognosis prediction model with prehospital and early clinical routine parameters and routine lab parameters was tested for predictive power.

[Vasopressin for therapy of persistent traumatic hemorrhagic shock: The VITRIS.at study].

While fluid management is established in controlled hemorrhagic shock, its use in uncontrolled hemorrhagic shock is being controversially discussed, because it may worsen bleeding. In the irreversible phase of hemorrhagic shock that was unresponsive to volume replacement, airway management and catecholamines, vasopressin was beneficial due to an increase in arterial blood pressure, shift of blood away from a subdiaphragmatic bleeding site towards the heart and brain and decrease of fluid resuscitation requirements. The purpose of this multicenter, randomized, controlled, international trial is to assess the effects of vasopressin (10 IU IV) vs.

Realistic assessment of the physician-staffed emergency services in Germany.

In Germany the emergency medical services, which include dispatching emergency physicians to the scene, are considered to be among the best in the world. However, the hospitals admitting these patients still report shortcomings in prehospital care. The quality of an emergency medical service depends on both formal qualification and experience in managing such emergencies.

[Pediatric cases in preclinical emergency medicine: critical aspects in the range of missions covered by ground ambulance and air rescue services].

Background: The aim of this study was to demonstrate differences in structure and severity of pediatric emergencies treated by aeromedical (air rescue) or ground ambulances services. Conclusions for the training of emergency physicians are discussed.

Patients And Methods: In a 3-year study period, a total of 9,274 pediatric emergencies covered by the ADAC air rescue service are compared to 4,344 pediatric patients of ground ambulance services in Saarland.

[Preclinical care of trauma patients in air rescue. Results of the medical quality management for patients with severe head injury and polytrauma in the years 2000 and 2001].

In a retrospective study of mission data of ADAC Air Rescue of the years 2000 and 2001 the quality of preclinical care of 1,946 patients with severe head injuries and 1,878 polytraumatized patients was examined. The actual preclinical care of these patients was compared with a catalogue of eleven thesis-like recommendations. These recommendations were previously derived from corresponding publications of national and international specialist companies and were introduced in a binding manner by the senior doctors of the participating air rescue centres.