JEMS : a journal of emergency medical services
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The explosion from the passing freight train rocked the nearby buildings, shattering the windows and letting off a thick cloud of poisonous gas. The building inhabitants were smoothly evacuated by commands given over the loudspeakers of the responding emergency workers. They walked quickly through the decontamination tents, following the directions of the hazmat team, and were transported without difficulty by squads and buses to local hospitals and trauma centers, where teams of medical professionals quickly and efficiently cared for them, using familiar protocols and equipment.
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We collected EMS-reported "last known normal" (LKN) times for patients brought to the ED with suspected acute stroke and calculated the absolute difference between the neurologist-determined and EMS-reported LKN times (deltaLKN). We determined the rate of inappropriate IV tissue plasminogen activator (tPA) use if the EMS-reported times were used instead of the neurologist-determined times. Of 251 patients, mean and median deltaLKN were 28 and 0 minutes, respectively. deltaLKN was < 15 minutes in 91% of the entire group and < 15 minutes in 80% of patients with a diagnosis of stroke. ⋯ Conversely, of patients who didn't receive IV tPA, 6% would have been incorrectly included for IV tPA consideration had the EMS time been used. In patients with wake-up stroke symptoms, EMS underestimated LKN times by an average of 208 minutes. All of the potentially incorrectly included patients would've been wake-up strokes.