The Effect of a County Prehospital FAST-ED Initiative on Endovascular Treatment Times Helen Rynor, BA,* Jake Levine, BS,* Joseph Souchak, BS,† Ned Shashoua, BS,† Maygret Ramirez, APRN, MSN, FNP, SCRN,† Ivis C. Gonzalez, BSN, RN, SCRN,† Virginia Ramos, MSN, APRN, FNP-BC, CNRN, SCRN,† Anshul Saxena, PhD,‡ Emir Veledar, PhD,‡ Amy K. Starosciak, PhD,* , † and Felipe De Los Rios La Rosa, MD* , † Background: Acute stroke outcomes depend on timely reperfusion. In 3/2017, local EMS agencies implemented a prehospital triage algorithm with hospital bypass and field activation of the neurointerventional team using the Field Assessment Stroke Triage for Emergency Destination (FAST-ED). A score 4 bypasses to a com- prehensive stroke center (CSC) and a score 6 also has the interventional team field activated off-hours. Aim: We analyzed effects of this initiative on volume, acute stroke transfers, treatment times, and outcomes and determined the tool’s ability to predict large vessel occlusion. Methods: Stroke cases brought to our center by EMS during 3/2016-2/2018 were analyzed, which included one year before and after FAST-ED implementation. Treatment times were compared on- vs. off-hours and to those with field activation. Results: Of 1153 patients, 761 (67%) were coded as stroke and 235 (20%) underwent reperfusion. Age, sex, race/ethnicity, stroke severity, length of stay, door-to-needle, and 90-d mRS were comparable between periods. Scale compliance was 85%. Concordance rate of §1 between EMS and calculated score was 53%. Compared to the previous year, door-to-puncture (DTP) improved by 17 min (p < 0.01) overall, 25 min (p < 0.001) off-hours, and 33 min (p < 0.05) with field activation. A cutoff of 4 vs. 6 would have led to 140% increase in field activations but only 36% increase in procedures. Conclusions: This prehospital initia- tive led to faster DTP by up to 33 min. The highest impact was off-hours with field activation. Only 1/3 of activations led to endovascular treatment. FAST-ED6 appears to be appropriate for field activation. Keywords: Stroke—Endovascular therapy—IV alteplase—Emergency response— Triage © 2020 Elsevier Inc. All rights reserved. Introduction Stroke is the fifth leading cause of death in the United States, with approximately 140,000 deaths per year, and a cost of $34 billion per year. 1 The most severe strokes are caused by large vessel occlusions (LVOs) which benefit the most from timely endovascular thrombectomy. In the US this therapy is reliably available only at thrombec- tomy-capable and comprehensive stroke centers (TSCs and CSCs, respectively). 2 It is therefore important that patients with LVO stroke are identified promptly as such and triaged appropriately to the right facility type. To better identify LVOs by first responders in the field, several symptom-based scores have been created. The From the *Florida International University Herbert Wertheim Col- lege of Medicine, Miami, FL USA; †Miami Neuroscience Institute, Baptist Health South Florida, Miami, FL USA; and ‡Center for Advanced Analytics, Baptist Health South Florida, Coral Gables, FL USA. Received April 17, 2020; revision received July 25, 2020; accepted July 28, 2020. Corresponding author at: Miami Neuroscience Institute, 2 Clarke, 8900 North Kendall Drive, Miami, FL 33176 USA. E-mail: felipedl@baptisthealth.net. 1052-3057/$ - see front matter © 2020 Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105220 Journal of Stroke and Cerebrovascular Diseases, Vol. 29, No. 11 (November), 2020: 105220 1