Spatial Analysis of Geographic Distribution and Accessibility of Suspected Acute Stroke Patients Transferred to Acute Stroke Centers by Emergency Medical Services in Tehran, Iran: A Cross-Sectional Study

Abstract

Objectives: We intended to map the geographical distribution of patients with acute stroke who called the Tehran EMS center based on the geographic information of the incident location on a map. The distributions of these centers and patients’ access within a standard period were evaluated. Methods: A cross-sectional study based on the registered data was conducted on suspected acute stroke patients > 18 years of age that were transferred by EMS. The analysis was performed based on pointing the patients’ locations and locating the hospitals in ArcGIS software plus a review of the polygons and focal points. Results: Totally, 1,606 patients suspected to stroke with a mean age of 64.89 ± 17.48 years were evaluated, of whom 947 (58.6%) were male. The mean time of arrival of an ambulance in the patient’s location from the EMS station was 11.94 ± 6.67 minutes, and the longest time was 69.32 minutes. The mean time from the patient’s location to the stroke center was 17.79 ± 11.42 minutes (range 2.4 - 83.70 minutes). Stroke centers in Tehran are not distributed in a balanced manner, and they are concentrated on the central and northern parts of Tehran, limiting access to hospital services. Conclusions: The multiplicity of hospitals in the west and center of Tehran led to an increase in access times in eastern Tehran. It emphasizes the necessity of revision of service locating, especially because the east of Tehran has a denser texture than the west.

Prehospital notification reduced time delays but not neurological outcomes in acute ischemic stroke

“…This hospital as a 724 code hospital has been equipped with a stroke center providing speci c care for acute ischemic stroke patients. Also SAMA code as a prehospital noti cation service has been established in order to quick transport of patients with a suspected stroke to 724 code hospital (5). As a whole, 724 code hospital and prehospital noti cation (SAMA) code were developed to rapidly identify and treat patients suspected to acute ischemic stroke.…”

“…One of these activities to reduce treatment delay is stabilization of prehospital noti cation. Prehospital noti cation for stroke in Iran, coded as SAMA, aims to reduce the treatment delay by rapidly identifying stroke-suspected patients who are positive in face, arm and speech tests (FAST), and by quickly transporting that patients to the comprehensive stroke centers, as well as by increasing alertness and readiness of the stroke centers for immediate treatment (5).…”

The Time Trend of Callssuspected of Having A Stroke with The Emergency Medical Services and Its Forecasting for The Next 5 Years in Iran

“…EMS personnel should be sophisticated enough tobe able to diagnose, examine, manage, treat, triageand transport stroke patients in a timely manner (14). In Iran, the system "724", which provide speci c services for acute stroke patients seven days a week and 24 hours a day and the code SAMA (Emergent Stroke) aimedat rapid identi cation and screening of patients suspected of acute stroke, andestablish better communication and coordination between the pre-hospital system and stroke centers for faster transmissionby either air or land, have been established since July 2015 (15). It seems necessary to assess factors associated with pre-hospital and hospital delay, the quality of provided care and individual factors associated with timely treatment in any society (16).…”

Examination of Ambulance Arrival Times by Geoinformatics Tools – Example of Borsod-Abaújzemplén County (Hungary)

“…There is a substantial body of literature available on this topic both from Hungary and internationally (Beke, 2019;Barry et al, 2018;Égi et al, 2015;Ishikawa, 2019;Kolivand, 2020;Knyazkov et al, 2015;Yasunaga et al, 2011), at various territorial levels, with slightly differing methodologies and demographic data.…”