Welcome to the thirty-ninth episode of AEM Early Access, a FOAMed podcast collaboration between the Academic Emergency Medicine Journal and Brown Emergency Medicine. Each month, we'll give you digital open access to a recent AEM Article or Article in Press, with an author interview podcast and suggested supportive educational materials for EM learners.

Find this podcast series on iTunes here.

DISCUSSING (CLICK ON TITLE FOR FULL TEXT, OPEN ACCESS THROUGH June 30, 2020):

Rubber Meeting the Road: Access to Comprehensive Stroke Care in the Face of Traffic. Daniel A. Dworkis MD, PhD, Sarah Axeen PhD, Sanjay Arora MD

LISTEN NOW: INTERVIEW WITH FIRST AUTHOR Daniel Dworkis MD, PhD

summary

Acute stroke is one of the leading causes of death in the United States, with an estimated annual cost of $34 billion and a death from stroke occurring approximately every 4 minutes. Early access to specialized stroke care is critically important in the treatment of suspected acute stroke, but access to dedicated stroke centers is unequal and varies geographically. Among the different levels of hospitals providing stroke care, the comprehensive stroke center (CSC) is the highest designation: CSCs utilize multidisciplinary stroke teams to provide the most advanced stroke care, including therapies like endovascular clot retrieval that are not available at most non-CSC hospitals.

Some patients with acute strokes may benefit from transport by emergency medical services (EMS) directly to CSC—even if this transport requires bypassing a closer, non-CSC stroke hospital—but identifying which patients is an area of ongoing investigation. In many systems of stroke care, if trans- port to a CSC is expected to take less than a certain number of minutes, the patient is taken to the CSC even if a non-CSC hospital is closer. Transport time–based decisions like these, however, could be significantly impacted during times of heavy traffic: road congestion from traffic is a serious problem in major U.S. cities, with commuters losing on average 97 hours a year due to traffic, at a total cost of $87 billion. This study examines the impact traffic has on intermittent access of populations to CSCs in LA County.