Abstract 3633: A National Assessment of Factors Influencing Emergency Medical Services Times Among Acute Stroke patients.
Background: The time spent in Emergency Medical Services [EMS] assessment and transport is a critical determinant of time interval between symptom onset and treatment for acute stroke.
Objective: To study the determinants that influence EMS times which is a composite of response, assessment, and transport times for acute stroke patients.
Methods: The 2009 national Emergency Services Information System [NEMSIS] Research dataset representing 26 states in US was accessed to identify the patients diagnosed by EMS personnel to be having stroke / cerebrovascular accident [CVA] on arrival at the scene of incident. Total EMS times defined as time interval between dispatch call and completion of transport to emergency department [reported in mins (confidence intervals)] were calculated and compared in various patient strata defined by factors such as dispatch center identification of stroke / CVA, barriers (language and physical) at the scene, location and demographical factors.
Results: A total of 52282 patients were identified to have stroke / CVA by EMS personnel on arrival at scene. Significant differences were seen in EMS times with accurate identification compared to non-identification of stroke / CVA by dispatch center [41.8 (41.5-42.2) vs 49.8 (49.3-50.2), P<0.001]. Language and physical barriers at scene were associated with EMS time delays [48.4 (47.3-49.6) vs 45.2 (44.8-45.6), P<0.001]. EMS times increased from urban to suburban, rural, and wilderness settings [42.6 (42.3-42.9) vs 48.6 (47.6-49.5) vs 50.5 (49.6-51.4) vs 62.4 (59.8-64.9), P<0.001]. Similarly, Pacific and Mid-Atlantic regions had faster EMS times compared to Mountain regions [35.2 (34.6-35.8) vs 36.5 (35.6-37.4) vs 46.6 (45.4-47.8), P<0.001]. Patients ≥65 years had less EMS times compared to those aged <65 years [44.9 (44.5-45.2) vs 46.9 (46.4-47.4), P<0.001].
Conclusion: EMS times in patients with acute stroke are influenced by multiple factors. A better understanding of modifiable and region specific factors can expedite time interval between symptom onset and treatment for acute stroke patients.
- © 2012 by American Heart Association, Inc.