Many stroke patients don’t arrive by ambulance

More than a third of stroke patients do not get to the hospital by ambulance, according to a study, even though that is the fastest way to get there.

Researchers studied records of more than 204,000 stroke patients arriving at EDs at 1,563 hospitals that participated in the American Heart Association/American Stroke Association’s Get With The Guidelines-Stroke quality improvement program in 2003-10.

As reported April 29 on the website of the journal Circulation: Cardiovascular Quality and Outcomes, emergency medical services transported 63.7% of the patients, with the rest arriving in various other ways, researchers said.

EMS transported 79% of those who got to the hospital within two hours of the start of their symptoms. That resulted in earlier arrival, quicker evaluation and faster treatment, said the researchers who also found:

• Almost 61% of people transported by EMS got to the hospital within three hours of the first symptoms, compared with 40% who did not use EMS;

• Almost 55% using EMS had a brain scan within 25 minutes of hospital arrival, compared with 35.6% who did not use EMS;

• Of patients eligible for a clot-busting drug, 67.3% using EMS received it within three hours of symptom onset, compared with 44.1% who did not use EMS.

“EMS are able to give the hospital a heads up, and that grabs the attention of the emergency room staff to be ready to act as soon as the patient arrives,” Jeffrey L. Saver, MD, the senior author of the study and director of the UCLA Comprehensive Stroke Center in Los Angeles, said in a news release.

“The ambulance crew also knows which hospitals in the area have qualified stroke centers. Patients don’t lose time going to one hospital only to be referred to another that can provide more advanced care if needed, whether that’s drugs to bust up the clot or device procedures to remove it.”

Minorities and rural residents were less likely to call for EMS at the signs of a stroke, the researchers found.

“A number of factors can fuel the reluctance to call 9-1-1,” said James Ekundayo, MD, DrPH, the study’s lead author and assistant professor in the Department of Family and Community Medicine at Meharry Medical College in Nashville, Tenn. “People may not recognize symptoms and may delay seeking medical care or call their doctor instead.

“We hear people say they didn’t want to be a bother, but many times there could have been a better outcome if EMS had been called.”

About 795,000 Americans experience a new or recurrent stroke each year. Boosting public awareness efforts and education is critical to improving stroke outcomes in the short term and long term, researchers said.

The American Heart Association/American Stroke Association’s Together to End Stroke, sponsored nationally by healthcare products leader Covidien, raises stroke awareness and educates Americans that stroke is largely preventable, treatable and beatable. The campaign includes a free mobile app that highlights the acronym F.A.S.T. to help people recognize a stroke:

• Face Drooping — Does one side of the face droop or is it numb? Ask the person to smile.

• Arm Weakness — Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?

• Speech Difficulty — Is speech slurred, or is the person unable to speak or hard to understand? Ask the person to repeat a simple sentence such as “The sky is blue.” Is the sentence repeated correctly?

• Time to call 9-1-1 — If the person shows any of these symptoms, even if the symptoms go away, they should get to the hospital immediately.

Read the study abstract:

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