Neurological emergencies comprise a wide range of conditions which include refractory seizures, acute stroke, traumatic brain and spinal cord injury, meningitis and encephalitis, hypoxic-ischemic encephalopathy, and acute neuromuscular conditions. While these may initially appear to represent disparate conditions, they share two important characteristics: earlier treatment is likely necessary to improve patient outcome and logistics of initial patient presentation pose major challenges to clinical trials of treatments for these conditions. The NINDS Neurological Emergencies Treatment Trials Network will create a national network of hub and spoke hospital systems to facilitate the conduct of streamlined clinical trials for neurological emergencies such as these. We propose SF-NET: the San Francisco Neurological Emergencies Trials network as one of these hub and spoke systems. SF-NET represents a scalable and flexible network of academic and community hospitals which can be configured and activated to maximize enrollment of eligible patients with neurological emergencies in the San Francisco Bay Area, completely covering a catchment area of up to 2 million people depending on the specific condition to be studied. SF-NET builds directly upon the prior successes of clinical trials for neurological emergencies conducted in San Francisco, most prominently the Prehospital Treatment of Status Epilepticus (PHTSE) trial which was conducted via a similar type of network in coordination with SF-EMSA paramedic and ambulance services. San Francisco General Hospital is a trauma center, stroke center, the SF-EMSA base hospital, and serves as the hub of SF-NET. Spoke hospitals include all eight SF-EMSA destination hospitals in San Francisco, all of which previously participated in PHTSE, as well as Alameda County Medical Center Highland Hospital, the trauma center in Oakland, included to enrich SF-NET in neurotrauma. SF-NET will work directly with NINDS and the NETT Clinical Coordinator Center to conduct at least 2 clinical trials of neurological emergencies via the network. Neurological emergencies such as refractory seizures, stroke, and neurotrauma have a major impact on public health and are challenging conditions to study because of the need for early intervention. A network to conduct streamlined trials for these conditions can bring new treatments to clinical care more rapidly.
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