Abstract 22: Geospatial Modeling To Optimize Mobile Stroke Unit System Deployment In A Large Metropolitan Region
IntroductionTransition from evidence to practice is the next challenge for Mobile Stroke Units (MSUs) now that two controlled studies have shown improved outcomes (BEST-MSU and B_PROUD). This requires successful integration into EMS systems. We sought to utilize geospatial mapping to identify the mo...
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Published in | Stroke (1970) Vol. 53; no. Suppl_1; p. A22 |
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Main Authors | , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Lippincott Williams & Wilkins
01.02.2022
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Abstract | IntroductionTransition from evidence to practice is the next challenge for Mobile Stroke Units (MSUs) now that two controlled studies have shown improved outcomes (BEST-MSU and B_PROUD). This requires successful integration into EMS systems. We sought to utilize geospatial mapping to identify the most efficient number and positioning of MSUs in Los Angeles (LA) County to maximize patient access. MethodsLA County has one of the largest EMS systems in the US, comprising 88 cities, more than 4000 sq miles, and a population of 10.2 million. Using ESRI/ArcGIS software, we performed geospatial mapping of all 911 calls resulting in a final diagnosis stroke from July 2016 - June 2019, converting street addresses to latitude/longitude. Regional heatmaps of stroke call volume were generated for day/evening (7 am-10 pm) vs nighttime (10 pm-7 am) and ischemic vs hemorrhagic stroke, superimposed upon available stroke centers and neighborhood sociodemographic factors. Based on pilot experience, each MSU was projected to be able to service a 10-mile radius. ResultsAmong 10,818 EMS responses for acute cerebrovascular disease during the 3-year study period, calls occurred during day/evening in 84.5% and nighttime in 15.5%. Stroke type was ischemic in 78.8% and hemorrhagic in 21.2%. Heat maps revealed multifocal geographic hotspots, with most active locations somewhat different for day/evening vs night and ischemic vs hemorrhagic. The spatial analysis algorithm determined that optimal placement of 5 MSUs in highest incidence areas would provide coverage for 87.0% of county stroke events. Positioning of 2 additional units in geographically isolated perimeter areas increased coverage to 91.9% of stroke events (Figure). ConclusionsGeospatial modeling can delineate the most efficient positioning of MSU resources within regionalized EMS systems of stroke care. Optimal position varies with time of day and with prioritization of coverage for ischemic vs hemorrhagic stroke. |
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AbstractList | Abstract only
Introduction:
Transition from evidence to practice is the next challenge for Mobile Stroke Units (MSUs) now that two controlled studies have shown improved outcomes (BEST-MSU and B_PROUD). This requires successful integration into EMS systems. We sought to utilize geospatial mapping to identify the most efficient number and positioning of MSUs in Los Angeles (LA) County to maximize patient access.
Methods:
LA County has one of the largest EMS systems in the US, comprising 88 cities, more than 4000 sq miles, and a population of 10.2 million. Using ESRI/ArcGIS software, we performed geospatial mapping of all 911 calls resulting in a final diagnosis stroke from July 2016 - June 2019, converting street addresses to latitude/longitude. Regional heatmaps of stroke call volume were generated for day/evening (7 am-10 pm) vs nighttime (10 pm-7 am) and ischemic vs hemorrhagic stroke, superimposed upon available stroke centers and neighborhood sociodemographic factors. Based on pilot experience, each MSU was projected to be able to service a 10-mile radius.
Results:
Among 10,818 EMS responses for acute cerebrovascular disease during the 3-year study period, calls occurred during day/evening in 84.5% and nighttime in 15.5%. Stroke type was ischemic in 78.8% and hemorrhagic in 21.2%. Heat maps revealed multifocal geographic hotspots, with most active locations somewhat different for day/evening vs night and ischemic vs hemorrhagic. The spatial analysis algorithm determined that optimal placement of 5 MSUs in highest incidence areas would provide coverage for 87.0% of county stroke events. Positioning of 2 additional units in geographically isolated perimeter areas increased coverage to 91.9% of stroke events (Figure).
Conclusions:
Geospatial modeling can delineate the most efficient positioning of MSU resources within regionalized EMS systems of stroke care. Optimal position varies with time of day and with prioritization of coverage for ischemic vs hemorrhagic stroke. IntroductionTransition from evidence to practice is the next challenge for Mobile Stroke Units (MSUs) now that two controlled studies have shown improved outcomes (BEST-MSU and B_PROUD). This requires successful integration into EMS systems. We sought to utilize geospatial mapping to identify the most efficient number and positioning of MSUs in Los Angeles (LA) County to maximize patient access. MethodsLA County has one of the largest EMS systems in the US, comprising 88 cities, more than 4000 sq miles, and a population of 10.2 million. Using ESRI/ArcGIS software, we performed geospatial mapping of all 911 calls resulting in a final diagnosis stroke from July 2016 - June 2019, converting street addresses to latitude/longitude. Regional heatmaps of stroke call volume were generated for day/evening (7 am-10 pm) vs nighttime (10 pm-7 am) and ischemic vs hemorrhagic stroke, superimposed upon available stroke centers and neighborhood sociodemographic factors. Based on pilot experience, each MSU was projected to be able to service a 10-mile radius. ResultsAmong 10,818 EMS responses for acute cerebrovascular disease during the 3-year study period, calls occurred during day/evening in 84.5% and nighttime in 15.5%. Stroke type was ischemic in 78.8% and hemorrhagic in 21.2%. Heat maps revealed multifocal geographic hotspots, with most active locations somewhat different for day/evening vs night and ischemic vs hemorrhagic. The spatial analysis algorithm determined that optimal placement of 5 MSUs in highest incidence areas would provide coverage for 87.0% of county stroke events. Positioning of 2 additional units in geographically isolated perimeter areas increased coverage to 91.9% of stroke events (Figure). ConclusionsGeospatial modeling can delineate the most efficient positioning of MSU resources within regionalized EMS systems of stroke care. Optimal position varies with time of day and with prioritization of coverage for ischemic vs hemorrhagic stroke. |
Author | Chidester, Cathy Liebeskind, David S Brown, Arleen F Sanko, Stephen Nour, May Gausche-Hill, Marianne Saver, Jeffrey L Vassar, Stefanie D Bosson, Nichole E Kazan, Clayton Eckstein, Marc |
AuthorAffiliation | Los Angeles, CA UCLA Depts of Neurology-Radiology, Los Angeles, CA Los Angeles County Fire Dept, Monterey Park, CA UCLA GIM AND HSR, Los Angeles, CA GEFFEN SCHOOL OF MEDICINE AT UCLA, Los Angeles, CA Los Angeles County EMS Agency, Santa Fe Springs, CA UNIVERSITY OF SOUTHERN CALIFORNIA, Los Angeles, CA UCLA, Los Angeles, CA LOS ANGELES COUNTY EMS AGENCY, Santa Fe Spgs, CA Los Angeles County EMS Agency, Santa Fe, CA |
AuthorAffiliation_xml | – name: UCLA Depts of Neurology-Radiology, Los Angeles, CA – name: LOS ANGELES COUNTY EMS AGENCY, Santa Fe Spgs, CA – name: UCLA GIM AND HSR, Los Angeles, CA – name: Los Angeles County EMS Agency, Santa Fe Springs, CA – name: UCLA, Los Angeles, CA – name: UNIVERSITY OF SOUTHERN CALIFORNIA, Los Angeles, CA – name: Los Angeles, CA – name: Los Angeles County Fire Dept, Monterey Park, CA – name: GEFFEN SCHOOL OF MEDICINE AT UCLA, Los Angeles, CA – name: Los Angeles County EMS Agency, Santa Fe, CA |
Author_xml | – sequence: 1 givenname: May surname: Nour fullname: Nour, May organization: UCLA Depts of Neurology-Radiology, Los Angeles, CA – sequence: 2 givenname: Stefanie D surname: Vassar fullname: Vassar, Stefanie D organization: Los Angeles, CA – sequence: 3 givenname: Arleen F surname: Brown fullname: Brown, Arleen F organization: UCLA GIM AND HSR, Los Angeles, CA – sequence: 4 givenname: Nichole E surname: Bosson fullname: Bosson, Nichole E organization: LOS ANGELES COUNTY EMS AGENCY, Santa Fe Spgs, CA – sequence: 5 givenname: Cathy surname: Chidester fullname: Chidester, Cathy organization: Los Angeles County EMS Agency, Santa Fe Springs, CA – sequence: 6 givenname: David S surname: Liebeskind fullname: Liebeskind, David S organization: UCLA, Los Angeles, CA – sequence: 7 givenname: Clayton surname: Kazan fullname: Kazan, Clayton organization: Los Angeles County Fire Dept, Monterey Park, CA – sequence: 8 givenname: Stephen surname: Sanko fullname: Sanko, Stephen organization: UNIVERSITY OF SOUTHERN CALIFORNIA, Los Angeles, CA – sequence: 9 givenname: Marc surname: Eckstein fullname: Eckstein, Marc organization: Los Angeles, CA – sequence: 10 givenname: Marianne surname: Gausche-Hill fullname: Gausche-Hill, Marianne organization: Los Angeles County EMS Agency, Santa Fe, CA – sequence: 11 givenname: Jeffrey L surname: Saver fullname: Saver, Jeffrey L organization: GEFFEN SCHOOL OF MEDICINE AT UCLA, Los Angeles, CA |
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Snippet | IntroductionTransition from evidence to practice is the next challenge for Mobile Stroke Units (MSUs) now that two controlled studies have shown improved... Abstract only Introduction: Transition from evidence to practice is the next challenge for Mobile Stroke Units (MSUs) now that two controlled studies have... |
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Title | Abstract 22: Geospatial Modeling To Optimize Mobile Stroke Unit System Deployment In A Large Metropolitan Region |
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