Helicopter EMS and its Outcomes in Stroke Patients during Transport from Rural ED to Comprehensive Stroke Center

The theory that will be examined in this review pertains to creating an algorithm based upon whether patients suffering from a stroke with a large vessel occlusion should be taken to a stroke center from rural emergency departments for a mechanical thrombectomy via helicopter EMS (HEMS) or ambulance transport. Such an algorithm does not exist in healthcare, so this literature review will have the potential to be clinically applicable. This review will aim to identify the proper method of transportation during an ischemic stroke with the goal of reducing mortality rates and improving outcomes. Most rural communities are over an hour away from the nearest hospital with a comprehensive stroke center. In time- sensitive events such as an ischemic stroke due to large vessel occlusion, outcome rates may be significantly lower in rural areas because local hospitals are distanced from tertiary stroke centers. The review was created using the following databases: PubMed, Google Scholar, and NCBI. Key search words: “Helicopter”, “EMS”, “stroke”, “tertiary”, “transport”. The results showed that the rates of thrombolysis were higher with HEMS when compared to ground ambulance transfer. HEMS has higher rates of thrombolysis, and thrombolysis is directly associated with better outcomes of stroke patients because the clot is being broken down. Long term cognitive function was significantly higher with HEMS and 90-day mortality was lower for HEMS patients versus ground transportation. Less time to thrombectomy was achieved with air transport in inter-hospital distances greater than 10 miles. Inter-hospital distances less than 10 miles yield better outcomes with ground transportation. Most rural hospital EDs are well over 10 miles from the nearest comprehensive stroke centers, which tend to be in urban areas. Therefore, rural HEMS is highly indicated to reduce these large hospital gaps