Novara is a bustling city in Italy’s Piemonte region in northwest Italy. It’s the capital city of Novara province, and an important crossroads along the route between Milan and Turin, and between Genoa and Switzerland. It is also the nerve centre for another critical operation – the coordination of emergency medical services in northeastern Piemonte.
The 118 Novara Operations Centre is a secondary-level public safety answering point located on the outskirts of the provincial capital. It coordinates the emergency resources throughout the region comprised of Novara and its three neighbouring provinces, Vercelli, Biella and Verbano-Cusio-Ossola. With a population of just less than one million, 118 Novara fields over 100,000 medical emergency calls per year and manages more than 270 health emergencies a day.
When a health emergency involves a suspected stroke, the team at 118 Novara knows that the quality of prehospital care is as important as the treatment they will receive in hospital, and that decisions made by emergency teams can affect treatment and contribute to the immediate, short-term and long-term outcomes for the patient.
The rapid evaluation test conducted remotely by the nurse at the operations centre in Novara, speedy diagnosis by the team on the ground, transport to the most suitable stroke-ready hospital, and the treatment administered by specialists, are all links in a chain involving several disciplines. The underlying complexity makes constant evaluation and optimisation critical, the 118 Novara team believes. This perspective dovetails with the chief objective of the EMS Angels Awards, namely to leverage quality monitoring and data-sharing to improve and standardise prehospital stroke care.
Under the direction of Dr Roberto Gioachin the 118 Novara joined MonitorICTUS, Italy’s quality monitoring project of the prehospital pathway, in 2021. The project evaluates the stroke management performance of territorial emergency services based on the efficiency parameters established by the European Society for Emergency Medicine (Eusem) and Angels. In October 2022, the 118 Novara Operations Centre was among five Italian and 57 European recipients of the second annual EMS Angels Awards announced at the Eusem congress in Berlin.
To qualify for the platinum award, they had to meet criteria that included a median on-scene time of 25-30 minutes, and prenotification and reporting of relevant patient information in 90% of cases. Most importantly, they had to provide 90% of stroke patients with emergency transport to one of the stroke-ready hospitals in the region.
“It is a pleasure and an honour to receive this award,” said Dr Matteo Rovera, the contact person for the stroke project of 118 Novara. “I thank Angels for their support. With their help we were able to evaluate ourselves, introduce corrections and improve our performance. We have also designed and introduced specific training courses for those who work in the area, and we are extending this training format to neighbouring territories.”
While in Berlin, Dr Rovera also had the opportunity to participate with EMS representatives from other European countries in the Angels Annual EMS Steering Committee Meeting. This round-table discussion of barriers and innovation in prehospital stroke care is one of the building blocks of an EMS community for Europe, one of several exciting developments to emerge from the awards.
On this occasion there were many familiar faces around the table. One month earlier, Dr Rovera had been among five Italian participants in Advanced Stroke Life Support (ASLS) training in Budapest, which was also attended by EMS specialists from Spain, Portugal, Poland, Romania, Hungary, Slovakia and the Czech Republic.
The ASLS curriculum was developed by the Gordon Centre, a designated centre of excellence of the University of Miami Miller School of Medicine, and is used around the world. Dr Rovera is now among the first five EMS specialists in Italy to become certified ASLS training providers, empowered to make an even broader impact on prehospital stroke care in their country.