Reorganisation of stroke care in prehospital emergency medical services: results through transformative learning
1Department of Emergency Medicine, Kanta-Häme Central Hospital, Ahvenistontie 20, FI-13530 Hämeenlinna, Finland
2Faculty of Education and Culture, Tampere University, FI-33014 University of Tampere, Finland
3Emergency Medical Services of Kanta-Häme, Kutalantie 1 B, FI-13210 Hämeenlinna, Finland
4Faculty of Medicine and Health Technology, Tampere University, FI-33014 Tampere University, Finland
Online publish date: 31 March 2021
Background: Rapid recanalisation is important when treating ischaemic stroke patients. In Finland, the reorganisation of the prehospital emergency medical system and the establishment of emergency medicine as an independent speciality occurred some years ago. These reforms offered the opportunity to develop new prehospital and in-hospital pathways for stroke patients.
Methods: In this retrospective study, we examined the immediate impact of implementing a new operating model in prehospital stroke care. We introduced a modified “load-and-go” model using a transformative learning process. We observed the immediate effects of the reorganisation by comparing prehospital time intervals three months before and three months after the reorganisation.
Results: The new operating model was implemented using a transformative learning process. There was an immediate reduction of 35.1% from 21.4 to 13.9 minutes (P < 0.001) in the median on-scene time and of 18.2% from 52.7 to 43.1 minutes (P < 0.05) in the median total time, i.e. the time interval between the alarm from the dispatch centre to patient hand-over to ED.
Conclusion: By using a transformative learning process in implementing a modified load-and-go operation model in the EMS, we could immediately reduce median on-scene time and median total time in the treatment of acute stroke patients.
Acute ischaemic stroke; Emergency medicine; Thrombolysis; Reorganisation; Prehos-pital emergency medical system
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