About this Research Topic
Recent advances in acute stroke therapy, endovascular clot retrieval and clot busting drugs, have re-focused emphasis on appropriate and timely transportation of patients for treatment. The implementation of these medical breakthroughs are equally as important as the clinical trials and are critical to translation of these trials findings. The implementation phases involve government policy, pre-hospital and hospital cares. At all stages, one needs to develop models with fair access for all patients to the best stroke therapy whether they live in metropolitan or remote areas. These desires need to be balanced by the limited workforce of neurologists with interest in stroke or stroke physicians.
Strides made in Google Maps, enable the citizen scientist to explore ideas in transportation and access to stroke therapy outside of confined traditional GIS packages. A variety of tools can now access Google and Bing Maps API allowing one to estimate transport time for different modes of transport and under variety of traffic conditions. Researchers have also incorporated these ideas into app development to help patient transport to the appropriate hospital. Additionally, maps of disease hotspots allow policy planners to visualize areas of need and appropriate allocation of resources. These maps can be displayed on the web, enabling user interaction and interrogation of the embedded data.
Complementing these advances, exploration of ideas in operational research can help the balancing act in determining appropriate hospitals for transport given the degree of stroke severity for that patient. A critical issue that has been recognized is whether patients with stroke should be transported to the nearest statewide clot retrieval hub (with 24-hour service) or any hospitals that can provide thrombolysis services. This conundrum has generated much discussion in the stroke community and has been phrased as “drip and ship versus direct to comprehensive stroke center”. These ideas have been discussed with the use of conditional probabilities of achieving reperfusion given distance from hub to triage. This key concept also impacted on the location of telemedicine sites. Is the telemedicine spoke site far enough for telemedicine service or not sufficiently far enough that the telemedicine consult can impede transfer to hub for clot retrieval therapy? These questions can be answered from looking at data after setting such service. However, it would be preferred to use modeling to estimate beforehand the likely benefit of setting up such service at a given location.
Finally, we need to consider issues with transportation. We often assume that ambulance travel time is much faster than that by car. This scenario may not be true as some countries do not allow ambulance travelling with light and sirens to drive the wrong way down the road. This is worrying as the population in metropolitan areas increases with time and timely transport of patients will become a major issue. We encourage experts in the field of transport to consider submitting article to this Research Topic.
The vision of this Research Topic in the Stroke section of Frontiers in Neurology is to discuss contemporary issues in pre-hospital care, emergency service transport of patients (including mobile stroke unit) and operational research into optimization of these transport models. It is hope that the discussion can stimulate the readers to design a transport model to meet their clinical needs. We encourage the authors to post their codes for papers.
Keywords: Geospatial, transport, model, access, stroke
Important Note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.