Abstract
Purpose: We report a questionnaire survey administered to emergency medical technicians (EMTs) to assess the transportation system by using a clinical indicator to thrombolytic therapy.Methods: The same questionnaire survey was administered to EMTs of Kawasaki City Fire Department in 2007 and 2010. The questionnaire consisted of acute stroke therapy, network system for accepting stroke victims, patient transportation, and Maria Prehospital Stroke Scale (MPSS). Quality assurance monitoring of a stroke-bypass transportation protocol was repeated every six months.Results: The response rates were 100% in 2007 (n=235) and 99% in 2010 (n=233). The rate of EMTs who recognized the success of stroke-bypass transportation for intravenous tissue plasminogen activator (iv-tPA) increased from 48% in 2007 to 66% in 2010. There were no significant differences in the rate of refusal of accepting stroke victims (75% in 2007, 81% in 2010) or transfer to hospitals in neighboring cities (42% in 2007, 41% in 2010). Most EMTs revealed a delay in the onset-to-detection and arrival-to-door times were barriers to prompt transportation. The rate of EMTs who completed the evaluation of MPSS within 1 min increased from 79.1% in 2007 to 86.4% in 2010. The rate of iv-tPA based on MPSS was 11–14%, while the rate of a modified Rankin Scale score <2 increased from 24.1% in the second half of 2009 to 39.0% in 2011.Conclusions: Triage of stroke victims by EMTs based on MPSS was conducted smoothly, and the outcome of iv-tPA improved along with EMTs’ recognition of the citywide stroke-bypass transportation system.
