Emergency medical services utilization and stroke treatment

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.