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{
    "pk": 9415,
    "title": "Acute Stroke: Current Evidence-based Recommendations for Prehospital Care",
    "subtitle": null,
    "abstract": "Introduction: \nIn the United States, Emergency Medical Services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with a suspected stroke and to compare these recommendations against the current protocols utilized by the 33 EMS agencies in the State of California.\n \nMethods: \nWe performed a literature review of the current evidence in the prehospital treatment of a patient with a suspected stroke and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the stroke protocols of each of the 33 EMS agencies for consistency with these recommendations.  The specific protocol components that we analyzed were the use of a stroke scale, blood glucose evaluation, use of supplemental oxygen, patient positioning, 12 lead ECG and cardiac monitoring, fluid assessment and intravenous access, and stroke regionalization. \n \nResults: \nProtocols across EMS agencies in California varied widely.  Most used some sort of stroke scale with the majority using the Cincinnati Prehospital Stroke Scale (CPSS).  All recommended the evaluation of blood glucose with the level for action ranging from 60 to 80mg/dL.  Cardiac monitoring was recommended in 58% and 33% recommended an ECG. More than half required the direct transport to a primary stroke center and 88% recommended hospital notification. \n \nConclusion: \nProtocols for a patient with a suspected stroke vary widely across the State of California.  The evidence-based recommendations that we present for the prehospital diagnosis and treatment of this condition may be useful for EMS medical directors tasked with creating and revising these protocols.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "Adult Acute Stroke Care 12-Lead EKG Stroke Stroke Care Stroke Care Emergency Medical Services Evidence-based Prehospital Protocols Regionalization Standardization"
        }
    ],
    "section": "Health Policy Analysis",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/5tc756dp",
    "frozenauthors": [
        {
            "first_name": "Nancy",
            "middle_name": "K.",
            "last_name": "Glober",
            "name_suffix": "",
            "institution": "University of California San Diego, Department of Emergency Medicine, San Diego, California",
            "department": "None"
        },
        {
            "first_name": "Karl",
            "middle_name": "A.",
            "last_name": "Sporer",
            "name_suffix": "",
            "institution": "EMS Medical Directors Association of California, California; University of California San Francisco, Department of Emergency Medicine, San Francisco, California",
            "department": "None"
        },
        {
            "first_name": "Kama",
            "middle_name": "Z.",
            "last_name": "Guluma",
            "name_suffix": "",
            "institution": "University of California San Diego, Department of Emergency Medicine, San Diego, California",
            "department": "None"
        },
        {
            "first_name": "John",
            "middle_name": "P.",
            "last_name": "Serra",
            "name_suffix": "",
            "institution": "University of California San Diego, Department of Emergency Medicine, San Diego, California",
            "department": "None"
        },
        {
            "first_name": "Joe",
            "middle_name": "A.",
            "last_name": "Barger",
            "name_suffix": "",
            "institution": "EMS Medical Directors Association of California, California",
            "department": "None"
        },
        {
            "first_name": "John",
            "middle_name": "F.",
            "last_name": "Brown",
            "name_suffix": "",
            "institution": "EMS Medical Directors Association of California, California; University of California San Francisco, Department of Emergency Medicine, San Francisco, California",
            "department": "None"
        },
        {
            "first_name": "Greg",
            "middle_name": "H.",
            "last_name": "Gilbert",
            "name_suffix": "",
            "institution": "EMS Medical Directors Association of California, California; Stanford University, Department of Emergency Medicine, Stanford, California",
            "department": "None"
        },
        {
            "first_name": "Kristi",
            "middle_name": "L.",
            "last_name": "Koenig",
            "name_suffix": "",
            "institution": "EMS Medical Directors Association of California, California; University of California Irvine, Center for Disaster Medical Sciences, Orange, California",
            "department": "None"
        },
        {
            "first_name": "Eric",
            "middle_name": "M.",
            "last_name": "Rudnick",
            "name_suffix": "",
            "institution": "EMS Medical Directors Association of California, California",
            "department": "None"
        },
        {
            "first_name": "Angelo",
            "middle_name": "A.",
            "last_name": "Salvucci",
            "name_suffix": "",
            "institution": "EMS Medical Directors Association of California, California",
            "department": "None"
        }
    ],
    "date_submitted": "2015-10-20T13:24:53-07:00",
    "date_accepted": "2015-10-20T13:24:53-07:00",
    "date_published": "2016-03-02T16:29:05-08:00",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/9415/galley/5285/download/"
        }
    ]
}