The White Whale.
The White Whale.
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白鲸。
DOI：
10.1161/strokeaha.119.025262
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发表时间：
2019
期刊：
影响因子：
8.3
通讯作者：
Goldstein,JoshuaN
中科院分区：
文献类型：
--
作者：
Zachrison,KoriS;Goldstein,JoshuaN
1044 2019 年 5 月中风的作者正在与这种退化曲线进行一场艰苦的斗争，因为 EMS 提供者在培训中接受的初始中风教育有限，而且在日常实践中很少遇到潜在的中风患者。事实上，院前和急救人员应对中风患者护理挑战的一个重要部分是认识到这是一个低频率、高风险的事件。研究报告称，这 3 个机构在 2 年的研究期间转运了 1805 名中风或疑似中风患者。在每年 55 000 次转运中，这意味着中风和疑似中风患者约占所有 EMS 转运的 1.6%。这些都是高风险、极其重要的运输，但在他们日常工作的宏伟计划中，这些都是罕见的事件。因此，当干预中的知识和技能应用得如此之少时，我们如何创建 EMS 流程，以促进记住所有关键步骤，同时简化文档并实现快速运输？这些提供商的合理期望是什么？这里遇到的挑战与开发低流行病筛查工具所遇到的挑战类似。 6 我们可能会考虑关注灾难准备或其他低频、高风险事件，在这些事件中正确完成工作至关重要。当这些提供者所做的大多数事情实际上与中风无关时，我们必须以某种方式知道如何做到这一点。总体而言，Oostema 等人的这项工作对院前卒中反应科学做出了宝贵贡献。研究设计包括制定教育干预措施的主要利益相关者，包括向 EMS 提供者提供持续的接触和教育的持续反馈，并导致干预后院前和院内表现的改善。最后，他们还跟踪了实际的患者临床结果。我们期待未来在这一领域开展工作，吸收从这项研究中吸取的一些重要经验教训。
1044 Stroke May 2019 authors was fighting an uphill battle against such a degradation curve, given the limited initial stroke education that EMS providers receive in their training and the infrequency with which potential stroke patients are encountered in their daily practice. And indeed, an important piece of responding to the challenge for prehospital and emergency providers in the care of stroke patients is in recognizing that this is a low-frequency, high-stakes event. The study reports that the 3 agencies transported 1805 stroke or suspected stroke patients over the 2-year study period. Out of 55 000 transports per year, this means that stroke and suspected stroke patients made up about 1.6% of all EMS transports. These are high-stakes, critically important transports, but in the grand scheme of their days’ work, these were infrequent events. So when the knowledge and skills from the intervention were being applied so infrequently, how do we create processes for EMS that facilitate remembering all of the critical steps, while also streamlining documentation and enabling rapid transport? What are reasonable expectations of these providers? The challenges encountered here are similar to the challenges encountered in developing a screening tool for a low-prevalence condition. 6 We might consider looking to disaster preparedness, or other places of low-frequency, highstakes events in which it is critically important to get it done right. Somehow we have to know how to do this when most of what these providers are doing is not actually related to stroke. Overall, this work of Oostema et al is a valuable contribution to the science of prehospital stroke response. The study design included key stakeholders in development of the educational intervention, included ongoing feedback to EMS providers for continued exposure and education, and led to improved prehospital and in-hospital performance after the intervention. Finally, they tracked actual patient clinical outcomes as well. We look forward to future work in this space, incorporating some of the important lessons learned from this study.