Seeking Help When Strokes Happen: A Study of 911 Tapes
Recommendations from the American Stroke Association stress the importance of treating stroke symptoms as medical emergencies and encourages the public to call 911 if they witness or experience a stroke. However, many patients experience delays from onset of symptoms to hospital arrival of 4 to 6 hours. Use of emergency medical service (EMS) is an important link in the chain of recovery. To investigate EMS use, tapes of calls to 911 were evaluated for 93 confirmed stroke cases arriving at the hospital by ambulance in 2 North Carolina counties during 1999. Tapes were transcribed and linked to EMS trip sheets. Seventy-two percent of patients were women, 30% were black, and their mean age was 76 years. Forty-three percent of the calls were placed by medical personnel and 37% by a family member. Only 5 of the 93 calls were made by the patient. In 42 (45%) of calls, the term “stroke” or “cerebrovascular accident” was recorded. In most instances (35 of 42) the term was first used by the caller. A decreased ability to walk or altered mental status were the two most frequently reported symptoms (30% each), followed by breathing difficulty (27%), impaired speech (25%), and muscle weakness (16%). In 78% of the calls, dispatchers sent EMS personnel to the scene at highest priority, with lights and sirens. The median time from dispatch to arrival of EMS personnel on the scene was 7 minutes. The median elapsed time from receiving the 911 call to the patient’s arrival at the hospital was 42 minutes. This study suggests that most 911 calls in these two counties were dispatched with highest priority. While EMS arrived in 7 minutes, it took more than one-half hour from arrival at the scene to reach the hospital. Few calls to 911 were made by the patients themselves. The information from this study will be useful in designing public health strategies to reduce prehospital delay for stroke patients.