Abstract WP247: Use and Importance of Emergency Medical Services in Rural Delivery of tPA in Acute Ischemic Stroke
Introduction: Data indicate approximately 60% of stroke patients use Emergency Medical Systems (EMS) to access medical care. EMS use is associated with improved door to physician and CT times in stroke treatment. Rural areas, however, may have limited EMS access and its use and impact on tPA delivery in this setting is unknown.
Hypothesis: We assessed the hypothesis that EMS use in tPA treated stroke patients would be lower in rural areas compared to urban areas. We also examined important time intervals between groups.
Methods: Prospective, observational study using previously collected data from 24 randomly selected Michigan community hospitals in the INSTINCT stroke trial. Hospitals were identified a priori as urban or rural using two models to account for varying rural definitions. Model 1 defined rural hospitals as those outside a Metropolitan Statistical Area (MSA). Model 2 used hospitals outside a major Urban Area (UA > 150 square miles). Descriptive statistics presented; Student’s t and X2 tests used in the comparisons.
Results: All 557 patients treated with tPA for AIS from 2007 - 2010 were included in the analysis. 82% [95% CI: 79%-85%] used EMS to access stroke care. Patients in both urban and rural groups had similar demographics. EMS transport times were significantly longer for rural patients in both models. Model 2, with a more restrictive geographic definition of a rural hospital, identified a significant reduction in EMS use in rural patients compared to the urban group. See Table.
Conclusions: Overall EMS use among stroke patients receiving tPA was substantially higher than previously reported in the general stroke population. Lower EMS use in rural settings, however, was confirmed in the restrictive model. EMS transport times were longer in the rural setting, likely reflecting greater travel distances. EMS level interventions to improve tPA delivery would reach a large majority of treated patients in both urban and rural settings.
- © 2012 by American Heart Association, Inc.