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Rural Field Consultation for Remote Acute Stroke Transport Decisions

Published online by Cambridge University Press:  03 June 2025

Marie-Andrée Panzini ,
Mary-Lou Halabi ,
Jillian Stang ,
Jessalyn K. Holodinsky Open the ORCID record for Jessalyn K. Holodinsky [Opens in a new window] ,
Annette Bredenkamp ,
Shannon Erfle ,
Balraj Mann ,
Gregory Vogelaar ,
John Montpetit  and
Thomas Jeerakathil Open the ORCID record for Thomas Jeerakathil [Opens in a new window]
...Show all authors
Marie-Andrée Panzini
Affiliation:
Department of Clinical Neurosciences, Centre Hospitalier Universite de Montreal, Montreal, Quebec, Canada
Mary-Lou Halabi
Affiliation:
Stroke Lead, Provincial Integration Improvement Network (past Cardiovascular Health and Stroke Strategic Clinical Network), Alberta Health Services, Edmonton, Alberta, Canada
Jillian Stang
Affiliation:
Senior Analyst, Data & Analytics, Alberta Health Services, Red Deer, Alberta, Canada
Jessalyn K. Holodinsky
Affiliation:
Department of Emergency Medicine, Department of Community Health Sciences, Department of Clinical Neurosciences, Centre for Health Informatics, Hotchkiss Brain Institute, O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
Annette Bredenkamp
Affiliation:
Referral, Access, Advice, Placement, Information & Destination (RAAPID), Alberta Health Services, Edmonton, Alberta, Canada
Shannon Erfle
Affiliation:
Senior Program Lead, Provincial Integration and Improvement Network, Past Executive Director, Cardiovascular and Stroke Strategic Clinical Network), Alberta Health Services, Edmonton, Alberta, Canada
Balraj Mann
Affiliation:
Senior Program Lead, Neuroscience and Stroke Provincial Integration Improvement Network (past Cardiovascular Health and Stroke Strategic Clinical Network), Alberta Health Services, Edmonton, Alberta, Canada
Gregory Vogelaar
Affiliation:
Emergency Medical Services. Alberta Health Services, Edmonton, Alberta, Canada
John Montpetit
Affiliation:
Referral, Access, Advice, Placement, Information & Destination (RAAPID), Alberta Health Services, Edmonton, Alberta, Canada
Thomas Jeerakathil
Affiliation:
Department of Medicine (Neurology), Faculty of Medicine and Dentistry, University of Alberta, University of Alberta Hospital, Edmonton, Alberta, Canada
Brian H. Buck
Affiliation:
Department of Medicine (Neurology), Faculty of Medicine and Dentistry, University of Alberta, University of Alberta Hospital, Edmonton, Alberta, Canada
Aravind Ganesh
Affiliation:
Department of Clinical Neurosciences & Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary & Foothills Medical Centre, Calgary, Alberta, Canada
Andrew M. Demchuk
Affiliation:
Department of Clinical Neurosciences & Hotchkiss Brain Institute, Department of Radiology, Cumming School of Medicine, University of Calgary & Foothills Medical Centre, Calgary, Alberta, Canada
Michael D. Hill*
Affiliation:
Department of Clinical Neurosciences & Hotchkiss Brain Institute, Department of Community Health Sciences, Department of Medicine, Department of Radiology, Cumming School of Medicine, University of Calgary & Foothills Medical Centre, Calgary, Alberta, Canada
*
Corresponding author: Michael D. Hill; Email: michael.hill@ucalgary.ca
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Abstract:

Background:

The best prehospital transport strategy for patients with suspected stroke due to possible large vessel occlusion varies by jurisdiction and available resources. A foundational problem is the lack of a definitive diagnosis at the scene. Rural stroke presentations provide the most problematic triage destination decision-making. In Alberta, Canada, the implementation and 5-year experience with a rural field consultation approach to provide service to rural patients with acute stroke is described.

Methods:

The protocols established through the rural field consultation system and the subsequent transport patterns for suspected stroke patients during the first 5 years of implementation are presented. Outcomes are reported using home time and data are summarized using descriptive statistics.

Results:

From April 2017 to March 2022, 721 patients met the definition for a rural field consultation, and 601 patients were included in the analysis. Most patients (n = 541, 90%) were transported by ground ambulance. Intravenous thrombolysis was provided for 65 (10.8%) of patients, and 106 (17.6%) underwent endovascular thrombectomy. The median time from first medical contact to arterial access was 3.2 h (range 1.3–7.6) in the direct transfers, compared to 6.5 h (range 4.6–7.9) in patients arriving indirectly to the comprehensive stroke center (CSC). Only a small proportion of patients (n = 5, 0.8%) were routed suboptimally to a primary stroke center and then to a CSC where they underwent endovascular therapy.

Conclusions:

The rural field consultation system was associated with shortened delays to recanalization and demonstrated that it is feasible to improve access to acute stroke care for rural patients.

Résumé :

RÉSUMÉ :

Consultations en milieu rural relatives à des décisions de transport à distance en cas d’AVC aigus.

Contexte :

Les meilleures stratégies de transport préhospitalier pour les patients soupçonnés d’avoir subi un AVC en raison d’une occlusion possible d’un gros vaisseau sanguin varient en fonction des juridictions et des ressources disponibles. Un problème fondamental demeure l’absence de diagnostic définitif effectué sur place. À cet égard, les cas d’AVC survenant en milieu rural sont ceux qui posent le plus de problèmes en termes de triage et de prise de décision. En Alberta, au Canada, nous entendons décrire la mise en œuvre et l’expérience sur cinq ans d’une approche de consultation sur le terrain pour fournir des services à des patients établis en milieu rural et victimes d’un AVC aigu.

Méthodes :

Les protocoles établis par le système de consultation rurale sur le terrain et les modalités subséquentes de transport pour les patients soupçonnés d’avoir subi un AVC au cours des cinq premières années de mise en œuvre sont présentés ici. Les résultats sont rapportés en fonction du temps passé à domicile et les données sont résumées à l’aide de statistiques descriptives.

Résultats :

D’avril 2017 à mars 2022, 721 patients répondaient à la définition d’une consultation en milieu rural. Au total, ce sont 601 d’entre eux qui ont été inclus dans l’analyse. La plupart des patients (n = 541, 90 %) ont été transportés par ambulance terrestre. Une thrombolyse intraveineuse a été réalisée pour 65 (10,8 %) des patients tandis que 106 (17,6 %) ont subi une thrombectomie endovasculaire (TEV). Le temps médian entre le premier contact médical et l’accès artériel était de 3,2 heures (intervalle : 1,3-7,6) dans les transferts directs contre 6,5 heures (intervalle : 4,6-7,9) chez les patients arrivant indirectement à un centre de soins complets de l’AVC. Seule une petite proportion de patients (n = 5, soit 0,8 %) a été acheminée de manière sous-optimale vers un centre de soins primaires de l’AVC, puis vers un centre de soins complets de l’AVC où ils ont bénéficié d’une TEV.

Conclusions :

Le système de consultation en milieu rural a permis de réduire les délais de re-canalisation et a démontré qu’il était possible d’améliorer l’accès des patients à des soins en cas d’AVC aigu.

Keywords

acute ischemic strokeemergency medical servicesendovascular therapyintravenous thrombolytic treatmentprehospital triage

Information

Type
Original Article
Information
Canadian Journal of Neurological Sciences , First View , pp. 1 - 7
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation

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