The polk county screening tool screening for detecting subarachnoid hemorrhage

Area of Science:

• Neurology
• Emergency Medicine
• Public Health

Background:

• Subarachnoid hemorrhage (SAH) is a critical stroke subtype with severe outcomes.
• SAH treatment requires specialized care at comprehensive stroke centers (CSCs).
• Timely diagnosis and transfer are crucial for SAH patients.

Purpose of the Study:

• To evaluate a novel three-step SAH protocol implemented by Polk County Fire Rescue (PCFR).
• To assess the protocol's impact on emergency medical services (EMS) SAH recognition and patient transfers.
• To determine the protocol's effectiveness in improving pre-hospital SAH care.

Main Methods:

• The study involved Polk County Fire Rescue (PCFR) serving 850,000 individuals.
• A three-step SAH protocol was implemented, incorporating Ottawa SAH criteria and EMS-identified symptoms.
• Acute management included medications like labetalol, levetiracetam, and ondansetron.

Main Results:

• Out of 2175 stroke patients, 80 screened positive for SAH.
• The interfacility transfer rate for potential SAH patients decreased significantly from 12.9% to 3.6%.
• Patients had a median age of 66, with 33% presenting with systolic BP over 220 mmHg.

Conclusions:

• The PCFR SAH protocol demonstrates effectiveness in field diagnosis and transfer decisions.
• Accurate pre-hospital SAH recognition by EMS can prevent unnecessary transfers and optimize patient care.
• The protocol shows potential for broader implementation to improve SAH outcomes nationwide.