Reliability of Field Assessment Stroke Triage for Emergency Destination Scale Use by Paramedics: Mobile Stroke Unit First-Year Experience.

Background and Purpose: Field Assessment Stroke Triage for Emergency Destination (FAST-ED) scale is a helpful tool to triage patients with stroke in the field. However, data on its reliability in the prehospital setting are lacking. We aim to test the reliability of FAST-ED scale when used by paramedics in a mobile stroke unit covering a metropolitan area. Methods: As part of standard operating mobile stroke unit procedures, paramedics initially evaluated patients. If the event characterized a stroke alert, the FAST-ED score was determined by the paramedic upon patient contact (in-person) and then independently by a vascular neurologist (VN) immediately after paramedic evaluation (remotely/telemedicine). This allowed testing of the interrater agreement of the FAST-ED scoring performance between on-site prehospital providers and remotely located VN. Results: Of a total of 238 patients transported in the first 15 months of the mobile stroke unit's activity, 173 were included in this study. Median age was 63 (interquartile range, 55.5­75) years and 52.6% were females. A final diagnosis of ischemic stroke was made in 71 (41%), transient ischemic attack in 26 (15%), intracranial hemorrhage in 15 (9%), whereas 61 (35%) patients were stroke mimics. The FAST-ED scores matched perfectly among paramedics and VN in 97 (56%) instances, while there was 0 to 1-point difference in 158 (91.3%), 0 to 2-point difference in 171 (98.8%), and 3 or more point difference in 2 (1.1%) patients. The intraclass correlation between VN and paramedic FAST-ED scores showed excellent reliability, intraclass correlation coefficient 0.94 (95% CI, 0.92­0.96; P<0.001). When VN recorded FAST-ED score ≥3, paramedics also scored FAST-ED≥3 in majority of instances (63/71 patients; 87.5%). A large vessel occlusion was identified in 16 (9.2%) patients; 13 occlusions were identified with a FAST-ED≥3 while 3 were missed. All of the latter patients had National Institutes of Health Stroke Scale score ≤5. Conclusions: We demonstrate excellent reliability of FAST-ED scale performed by paramedics when compared with VN, indicating that it can be accurately performed by paramedics in the prehospital setting.

A backward glance.

Medical illustrators have sought statutory regulation and a protected title to demonstrate credibility and status within the field of healthcare and to enhance practitioner's reputation. This has proved to be a challenging journey that has been intensely political. This paper summarises that journey to date.

The FAST-ED App: A Smartphone Platform for the Field Triage of Patients With Stroke.

BACKGROUND AND PURPOSE: The Emergency Medical Services field triage to stroke centers has gained considerable complexity with the recent demonstration of clinical benefit of endovascular treatment for acute ischemic stroke. We sought to describe a new smartphone freeware application designed to assist Emergency Medical Services professionals with the field assessment and destination triage of patients with acute ischemic stroke. METHODS: Review of the application's platform and its development as well as the different variables, assessments, algorithms, and assumptions involved. RESULTS: The FAST-ED (Field Assessment Stroke Triage for Emergency Destination) application is based on a built-in automated decision-making algorithm that relies on (1) a brief series of questions assessing patient's age, anticoagulant usage, time last known normal, motor weakness, gaze deviation, aphasia, and hemineglect; (2) a database of all regional stroke centers according to their capability to provide endovascular treatment; and (3) Global Positioning System technology with real-time traffic information to compute the patient's eligibility for intravenous tissue-type plasminogen activator or endovascular treatment as well as the distances/transportation times to the different neighboring stroke centers in order to assist Emergency Medical Services professionals with the decision about the most suitable destination for any given patient with acute ischemic stroke. CONCLUSIONS: The FAST-ED smartphone application has great potential to improve the triage of patients with acute ischemic stroke, as it seems capable to optimize resources, reduce hospital arrivals times, and maximize the use of both intravenous tissue-type plasminogen activator and endovascular treatment ultimately leading to better clinical outcomes. Future field studies are needed to properly evaluate the impact of this tool in stroke outcomes and resource utilization.

Arcanobacterium haemolyticum osteomyelitis and sepsis: a diagnostic conundrum.

BACKGROUND: Arcanobacterium haemolyticum can cause severe systemic infections and sepsis. Thus, accurate and timely identification of the organism is essential. METHODS: Case report and review of the pertinent English-language literature. CASE REPORT: A 74-year-old male underwent repetitive surgical debridement and grafting for a full-thickness ulcer on the plantar surface of the left foot. One week after the last debridement, the patient presented to the emergency department with fever, hypotension, and severe left foot pain. A radiograph showed a soft-tissue defect of the plantar aspect of the left midfoot with gas along the lateral aspect of the fifth metatarsal. A below-knee amputation was performed. Blood culture and intraoperative tissue specimens grew colonies that exhibited ß-hemolysis on sheep blood agar and agglutinated with streptococcal B group antiserum. However, gram staining revealed that the organism was a gram-positive bacillus, and a reverse Christie, Atkins, Munch-Peterson (CAMP) test showed that the organism inhibited the ß-hemolysis of Staphylococcus aureus on sheep blood agar. Biochemical testing identified the organism as A. haemolyticum. CONCLUSIONS: It is important to investigate for A. haemolyticum when organisms with ß-hemolytic activity react with group B streptococcal antiserum. Otherwise, A. haemolyticum can be mis-identified as group B Streptococcus or Listeria monocytogenes. This distinction is important clinically, because despite good in vitro activity of penicillin (a first-line antibiotic for group B Streptococcus infections), treatment failures have been reported when penicillin has been used for A. haemolyticum infections.

The regulation of clinical photographers.

A long-held ambition for the regulation of clinical photographers is soon to be realized: in September 2004 the Health Professions Council formally approved an application by the Council for the Accreditation of Medical Illustration Practitioners, and it is anticipated that clinical photographers will be amongst the first group of healthcare scientists to join the national state register in 2005. This paper describes the application process and the ramifications for the profession.