The Polk Country Fire Rescue screening tool for detecting subarachnoid hemorrhage

The Polk Country Fire Rescue screening tool for detecting subarachnoid hemorrhage

Subarachnoid hemorrhage, Prehospital stroke, Intracerebral hemorrhage

Abstract
Introduction The subarachnoid space in the brain contains crucial blood vessels and cerebrospinal fluid. Aneurysms
in these vessels can lead to subarachnoid hemorrhage (SAH), a serious stroke subtype with high morbidity and
mortality rates. SAH treatment includes procedures like coiling and clipping, but these are available only at
comprehensive stroke centers (CSCs), necessitating urgent diagnosis and transfer to specialized facilities.
Methods This IRB-approved study was conducted by Polk County Fire Rescue (PCFR) in Florida. PCFR, serving an
850,000-person population, implemented a three-step SAH protocol. The protocol uses both Ottawa SAH criteria and
recurring symptoms, such as new-onset seizures and high systolic blood pressure, that were identified by EMS. Acute
management included administering labetalol, levetiracetam, and ondansetron.
Results Of 2175 stroke patients, 80 screened positive for SAH and were eligible for transfer. Patients had a median
age of 66, and 33% had an initial systolic BP over 220 mmHg. The interfacility transfer rate dropped from 12.9 to 3.6%
after implementing the protocol.
Conclusion The PCFR protocol’s effectiveness suggests its potential for nationwide implementation. Early SAH
recognition and prompt transfer to CSCs reduce complications and improve outcomes. Accurate field diagnosis
by EMTs can prevent unnecessary transfers and enhance patient care. Future improvements may include portable
diagnostic tools and enhanced EMT training to further improve SAH patients’ pre-hospital care.
Keywords Subarachnoid hemorrhage, Prehospital stroke, Intracerebral hemorrhage

Krish Patel1
, Sanjana Konda2

, Latha Ganti2,3*, Anjali Banerjee4

and Paul Banerjee5

https://doi.org/10.1186/s12245-024-00722-1

2024

Peri Irawan

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