Drip ‘n Ship Versus Mothership for Endovascular Treatment Modeling the Best Transportation Options for Optimal Outcomes

The solution to this is so goddamned easy. You get objective diagnosis of ischemic stroke in the ambulance without the need for a neurologist to read anything. Not scanners in the ambulance. Then deliver tPA in the ambulance, no need to get inside a hospital.
Maybe these 17 diagnosis possibilities to find out which one is the best? Or maybe the Qualcomm Xprize for the tricorder?
These people are only thinking of what is currently capable rather than what the best solution is and figure out a way to get there. They are stuck in the past just like your doctor who hasn't read a single research article since medical school. You don't want these people anywhere near you.


http://stroke.ahajournals.org/content/early/2017/01/18/STROKEAHA.116.015321 

Matthew S.W. Milne, Jessalyn K. Holodinsky, Michael D. Hill, Anders Nygren, Chao Qiu, Mayank Goyal, Noreen Kamal

https://doi.org/10.1161/STROKEAHA.116.015321

Stroke. 2017;STROKEAHA.116.015321

Originally published January 18, 2017

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Abstract

Background and Purpose—There is uncertainty regarding the best way for patients outside of endovascular-capable or Comprehensive Stroke Centers (CSC) to access endovascular treatment for acute ischemic stroke. The role of the nonendovascular-capable Primary Stroke Centers (PSC) that can offer thrombolysis with alteplase but not endovascular treatment is unclear. A key question is whether average benefit is greater with early thrombolysis at the closest PSC before transportation to the CSC (Drip ‘n Ship) or with PSC bypass and direct transport to the CSC (Mothership). Ideal transportation options were mapped based on the location of their endovascular-capable CSCs and nonendovascular-capable PSCs.

Methods—Probability models for endovascular treatment were developed from the ESCAPE trial’s (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times) decay curves and for alteplase treatment were extracted from the Get With The Guidelines decay curve. The time on-scene, needle-to-door-out time at the PSC, door-to-needle time at the CSC, and door-to-reperfusion time were assumed constant at 25, 20, 30, and 115 minutes, respectively. Emergency medical services transportation times were calculated using Google’s Distance Matrix Application Programming Interface interfaced with MATLAB’s Mapping Toolbox to create map visualizations.

Results—Maps were generated for multiple onset-to-first medical response times and door-to-needle times at the PSCs of 30, 60, and 90. These figures demonstrate the transportation option that yields the better modeled outcome in specific regions. The probability of good outcome is shown.

Conclusions—Drip ‘n Ship demonstrates that a PSC that is in close proximity to a CSC remains significant only when the PSC is able to achieve a door-to-needle time of ≤30 minutes when the CSC is also efficient. (DTN<30 minutes is pathetic, it should be negative, figure out a way to get there.)