(Stroke. 2000;31:1925.)
© 2000 American Heart Association, Inc.
Original Contributions |
Activation of Emergency Medical Services for Acute Stroke in a Nonurban Population
The T.L.L. Temple Foundation Stroke Project
From the Stroke Program, Department of Neurology, University of Texas Medical School–Houston (T.H.W., L.S., R.F., S.L.H., J.C.G., A.M.D., L.B.M.); Department of Family Practice, University of Texas Medical School–Houston (J.G.); and School of Public Health, University of Texas–Houston (W.C., L.K.B., L.B.M.).
Correspondence to Lewis B. Morgenstern, MD, Stroke Program, Department of Neurology, University of Texas–Houston, 6431 Fannin, MSB 7.044, Houston, TX 77030. E-mail Lewis.Morgenstern{at}uth.tmc.edu
Background and Purpose—Activating emergency medical services (EMS) is the most important factor in reducing delay times to hospital arrival for stroke patients. Determining who calls 911 for stroke would allow more efficient targeting of public health initiatives.
Methods—The T.L.L. Temple Foundation Stroke Project is an acute stroke surveillance and intervention project in nonurban East Texas. Prospective case ascertainment allowed chart abstraction and structured interviews for all hospitalized stroke patients to determine if EMS was activated, and if so, by whom.
Results—Of 429 validated strokes, 38.0% activated EMS by
calling 911. Logistic regression analysis comparing those who
called 911 with those who did not activate EMS found that
individuals who were employed were 81% less likely to have EMS
activated (OR 0.19, 95% CI 0.04 to 0.63). Of the 163 cases in
which 911 was called, the person activating EMS was: self (patient),
4.3%; family member of significant other, 60.1%; paid caregiver,
18.4%; and coworker or other, 12.9%. Significant associations between
the variables age group (P=0.02), insurance status
(P=0.007), and living alone (P=0.05) with
who called 911 was found on 
2 analysis.
Conclusions—Educational efforts directed at patients themselves at risk for stroke may be of low yield. To increase the use of time dependent acute stroke therapy, interventions may wish to concentrate on family, caregivers, and coworkers of high-risk patients. Large employers may be good targets to increase utilization of EMS services for acute stroke.
Key Words: ambulance • education • emergency medical services • stroke, acute
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