Colchester and Milton rescue teams recently participated in a stroke assessment training with the University of Vermont Medical Center that has the potential to save time and lives, especially in rural areas.
Dr. Dan Wolfson, Vermont State EMS medical director and emergency medicine physician with UVMMC, led the group training in a project called FAST-ED, or field assessment stroke triage for emergency destination. FAST-ED is an app that was built “pro bono,” meant to improve stroke care, especially in rural areas.
FAST-ED allows emergency medical technicians to assess stroke patients in the field to calculate the probability of them experiencing a more severe type of stroke, called a large vessel occlusion, Wolfson explained. He said these strokes can be treated with surgery called a thrombectomy to remove a blood clot in the brain and reverse symptoms.
“Of all the people that have strokes, only a very small percentage have these large vessel occlusions, maybe 10 percent,” Wolfson said. “We want to know which patients have these, because those are the ones that are going to be good candidates for a thrombectomy.”
However, thrombectomies can only be performed at three area hospitals: UVMMC, Dartmouth-Hitchcock and Albany in New York. Previously, EMTs would take patients to the nearest community hospital, assess them and then decide if they needed to be taken to a larger hospital to perform the surgery, Wolfson said.
In EMS District 3, where Colchester and Milton rescue teams operate, stroke patients would be transported to UVM regardless of the severity of stroke, Wolfson explained. District 3 EMS groups will participate in the study to help validate the app in the field. Once that happens, FAST-ED can be rolled out statewide, Wolfson said.
“Patients would potentially get diverted to the most appropriate destination hospital based on the time of onset of the stroke and how severe their symptoms are,” he said.
Colchester and Milton rescue crews were excited to join the study. Milton public safety director Taylor Yeates said the protocol won’t be adopted until the research proves it’s worth it.
“In the future we should be able to save more lives,” he said.
Yeates said the app won’t change where his team takes stroke patients, but it could possibly save time in the emergency room where patients are treated. The app could alert the medical teams that perform thrombectomies, for example.
“[If] it’s recognized 20 minutes early, we can call in the middle of the night and they can page up the doctor and have them ready for you,” Yeates said.
Colchester Rescue Chief Scott Crady said his crew is skilled at diagnosing strokes, but the training will only improve it and streamline their response in the process.
“When you do stroke assessment, it’s not black and white,” he said. “It’s good if we can be part of a study to help agencies that are out there in the rural areas be able to give an assessment and then transport to a facility that’s going to give the best help.”
Wolfson said the program was recently endorsed by the American Heart Association after new research came out last year showing patients have a 24-hour window to get a thrombectomy after first showing stroke symptoms. The window was previously only be six hours, and it was more difficult for patients to get the proper care in time, he added.
After the window increased, Wolfson said Vermont EMS changed its protocols to match the AHA recommendations and started looking into using FAST-ED.
“If those signs of the stroke started within 24 hours, they notify the hospital that there is a stroke alert patient coming in,” Wolfson said. “Getting the right patient to the right place at the right time is going to improve patient care, improve outcomes and save costs.”