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(Stroke. 2007;38:2765.)
© 2007 American Heart Association, Inc.

Original Contributions

The Impact of Ambulance Practice on Acute Stroke Care

Ian Mosley, MBus; Marcus Nicol, PhD; Geoffrey Donnan, MD; Ian Patrick, ASM; Fergus Kerr, MBBS Helen Dewey, PhD

From the National Stroke Research Institute (I.M., M.N., G.D., H.D.), Australia; University of Melbourne (I.M., M.N.), Melbourne, Australia; Department of Medicine (G.D., H.D.), University of Melbourne, Melbourne, Australia; Department of Neurology (G.D., H.D.), Austin Health, Melbourne, Australia; Metropolitan Ambulance Service (I.P.), Melbourne, Australia; and the Emergency Department (F.K.), Austin Health, Melbourne, Australia.

Correspondence to Ian Mosley, National Stroke Research Institute, Level 1 Neurosciences Building, Austin Health, 300 Waterdale Road, Heidelberg Heights Victoria 3181, Australia. E-mail imosley{at}nsri.org.au

Background and Purpose— Few patients with acute stroke are treated with alteplase, often due to significant prehospital delays after symptom onset. The aims of this study were to: (1) identify factors associated with rapid first medical assessment in the emergency department after a call for ambulance assistance, and (2) determine the impact of ambulance practice on times from the ambulance call to first medical assessment in the emergency department.

Methods— During a 6-month period in 2004, all ambulance-transported patients with stroke or transient ischemic attack arriving from a geographically defined region in Melbourne, Australia (population 383 000) to one of 3 hospital emergency departments were assessed prospectively. Ambulance records including the tape recording of the call for ambulance assistance and hospital medical records, were analyzed.

Results— One hundred ninety-eight patients were included in the study. One hundred eighty-seven ambulance patient care records were complete and available for analysis. Factors associated with first medical assessment in the emergency department <60 minutes from the ambulance call and <10 minutes from hospital arrival were: Glasgow Coma Scale <13 (P<0.001 and P=0.021) and hospital prenotification (P=0.04 and P<0.001). Paramedic stroke recognition and hospital prenotification were associated with shorter times from the ambulance call to first medical assessment (P=0.001 and P<0.001).

Conclusions— Paramedic stroke recognition and hospital prenotification are associated with shorter prehospital times from the ambulance call to hospital arrival and in-hospital times from hospital arrival to first medical assessment. This highlights the importance of including ambulance practice in comprehensive care pathways that span the whole process of stroke care.

Key Words: acute stroke • awareness • emergency care • paramedics