Online Program

Emergency medical services utilization and stroke treatment

Tuesday, November 3, 2015 : 5:00 p.m. - 5:15 p.m.

David J. Reynen, DrPH, MA, MPPA, MPH, CPH, California Stroke Registry/California Coverdell Program, California Department of Public Health, Sacramento, CA
Alisa S. Kamigaki, MPH, California Stroke Registry/California Coverdell Program, California Department of Public Health, Sacramento, CA
Janet Bates, MD, MPH, Chronic Disease Control Branch, California Department of Public Health, Sacramento, CA
Background: The need to utilize emergency medical services (EMS) in the event of an acute stroke has been well communicated; however, a considerable number of individuals still utilize other means.  Using statewide data (2014), this study examined stroke patients and their treatment, by EMS use.

Methods: Stroke patients (n=10,370) were stratified into two mode-of-transport groups: EMS and non-EMS.  Descriptive statistics were used for group comparisons and for treatment-related time intervals of interest, including “Door-to-CT” (i.e., the interval from hospital arrival to brain imaging) and “Door-to-Needle” (i.e., the interval from hospital arrival to IV thrombolytic therapy).  Difference of proportions and t-tests assessed statistical significance.

Results: More than half of the patients (59.8%) arrived via EMS.  These patients were, relative to those in the non-EMS group, more likely to be female (52.0% vs. 48.0%; p<0.05); more likely to be African American (8.5% vs. 6.2%; p<0.05); older (mean age in years: 72.5 vs. 69.6; p<0.05); and more likely to have had a more severe stroke (NIH Stroke Scale mean score: 8.1 vs. 2.9; p<0.05).  Patients transported via EMS were also more likely to have a “Door-to-CT” time of 25 minutes or less (43.7% vs. 14.9%; p<0.05) and a lower mean “Door-to-Needle” time (60.2 minutes vs. 65.8 minutes; p<0.05).

Conclusions: Patients arriving via EMS are more likely than those arriving via other means to receive earlier imaging and thrombolysis.  Public education should emphasize the role of EMS in optimizing patient treatment for acute stroke and should target individuals utilizing other means of transport.

Learning Areas:

Advocacy for health and health education
Chronic disease management and prevention
Clinical medicine applied in public health
Provision of health care to the public

Learning Objectives:
Compare stroke patients using EMS to those not using EMS. List the differences in treatment outcomes, by EMS use. Discuss the importance of utilizing EMS for acute stroke.

Keyword(s): Emergency Medical Services, Strokes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the co-principal investigator of the California Stroke Registry/California Coverdell Program and have been since its inception. For the present study, I, together with my colleagues, conceptualized the research; obtained and analyzed the data; interpreted and summarized the results; and wrote the abstract.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4425.0: Emergency Medical Services