TY - JOUR
T1 - Need to Prioritize Education of the Public Regarding Stroke Symptoms and Faster Activation of the 9-1-1 System
T2 - Findings from the Florida–Puerto Rico CReSD Stroke Registry
AU - Gardener, Hannah
AU - Pepe, Paul E.
AU - Rundek, Tatjana
AU - Wang, Kefeng
AU - Dong, Chuanhui
AU - Ciliberti, Maria
AU - Gutierrez, Carolina
AU - Gandia, Antonio
AU - Antevy, Peter
AU - Hodges, Wayne
AU - Mueller-Kronast, Nils
AU - Sand, Charles
AU - Romano, Jose G.
AU - Sacco, Ralph L.
N1 - Funding Information:
This work was supported by the National Institutes of Health (NIH)/National Institute of Neurological Disorders and Stroke (NINDS) under grant # U54-NS081763.
Publisher Copyright:
© 2018, © 2018 National Association of EMS Physicians.
PY - 2019/7/4
Y1 - 2019/7/4
N2 - Objective: Demographic differences (race/ethnicity/sex) in 9-1-1 emergency medical services (EMS) access and utilization have been reported for various time-dependent critical illnesses along with associated outcome disparities. However, data are lacking with respect to measuring the various components of time taken to reach definitive care facilities following the onset of acute stroke symptoms (i.e., stroke onset to 9-1-1 call, EMS response, time on-scene, transport interval) and particularly with respect to any differences across ethnicities and sex. Therefore, the specific aim of this study was to measure the various time intervals elapsing following the first symptom onset (FSO) from an acute stroke until stroke hospital arrival (SHA) and to delineate any race/ethnic/sex-related differences among any of those measurements. Methods: The Florida-Puerto Rico Stroke Registry (FLPRSR) is an on-going, voluntary stroke registry of hospitals participating in the Get with the Guidelines-Stroke initiative. The study population included patients treated at Florida hospitals participating in the FLPRSR between 2010 and 2014 who had called 9-1-1 and were managed and transported by EMS. In total, 10,481 patients (16% black, 8% Hispanic, 74% white) had complete data-sets that included birthdate/year, sex, ethnic background, date/hour/minute of FSO and date/hour/minute of EMS response, scene arrival, and SHA. Results: Median time from FSO to SHA was 339 minutes (interquartile range [IQR] of 284–442), 301 of which constituted the time elapsed from FSO to the 9-1-1 call (IQR =249–392) versus only 10 from 9-1-1 call to EMS arrival (IQR =7–14), 14 on-scene (IQR =11–18) and 12 for transport to SHA (IQR =8–19). The FSO to 9-1-1 call interval, being by far the longest interval, was longest among whites and blacks (302 minutes for both) versus 291 for Hispanics (p = 0.01). However, this 11-minute difference was not deemed clinically-significant. There were neither significant sex-related differences nor any racial/ethnic/sex differences in the relatively short EMS-related intervals. Conclusions: Following acute stroke onset, time elapsed for EMS response and transport is relatively short compared to the lengthy intervals elapsing between symptom onset and 9-1-1 system activation, regardless of demographics. Exploration of innovative strategies to improve public education regarding stroke symptoms and immediate 9-1-1 system activation are strongly recommended.
AB - Objective: Demographic differences (race/ethnicity/sex) in 9-1-1 emergency medical services (EMS) access and utilization have been reported for various time-dependent critical illnesses along with associated outcome disparities. However, data are lacking with respect to measuring the various components of time taken to reach definitive care facilities following the onset of acute stroke symptoms (i.e., stroke onset to 9-1-1 call, EMS response, time on-scene, transport interval) and particularly with respect to any differences across ethnicities and sex. Therefore, the specific aim of this study was to measure the various time intervals elapsing following the first symptom onset (FSO) from an acute stroke until stroke hospital arrival (SHA) and to delineate any race/ethnic/sex-related differences among any of those measurements. Methods: The Florida-Puerto Rico Stroke Registry (FLPRSR) is an on-going, voluntary stroke registry of hospitals participating in the Get with the Guidelines-Stroke initiative. The study population included patients treated at Florida hospitals participating in the FLPRSR between 2010 and 2014 who had called 9-1-1 and were managed and transported by EMS. In total, 10,481 patients (16% black, 8% Hispanic, 74% white) had complete data-sets that included birthdate/year, sex, ethnic background, date/hour/minute of FSO and date/hour/minute of EMS response, scene arrival, and SHA. Results: Median time from FSO to SHA was 339 minutes (interquartile range [IQR] of 284–442), 301 of which constituted the time elapsed from FSO to the 9-1-1 call (IQR =249–392) versus only 10 from 9-1-1 call to EMS arrival (IQR =7–14), 14 on-scene (IQR =11–18) and 12 for transport to SHA (IQR =8–19). The FSO to 9-1-1 call interval, being by far the longest interval, was longest among whites and blacks (302 minutes for both) versus 291 for Hispanics (p = 0.01). However, this 11-minute difference was not deemed clinically-significant. There were neither significant sex-related differences nor any racial/ethnic/sex differences in the relatively short EMS-related intervals. Conclusions: Following acute stroke onset, time elapsed for EMS response and transport is relatively short compared to the lengthy intervals elapsing between symptom onset and 9-1-1 system activation, regardless of demographics. Exploration of innovative strategies to improve public education regarding stroke symptoms and immediate 9-1-1 system activation are strongly recommended.
KW - 9-1-1 dispatcher
KW - EMS
KW - race/ethnicity
KW - response intervals
KW - stroke
KW - stroke center
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U2 - 10.1080/10903127.2018.1525458
DO - 10.1080/10903127.2018.1525458
M3 - Article
C2 - 30239244
AN - SCOPUS:85055544445
SN - 1090-3127
VL - 23
SP - 439
EP - 446
JO - Prehospital Emergency Care
JF - Prehospital Emergency Care
IS - 4
ER -