Stroke Symptoms and the Decision to Call for an Ambulance

Mosley, Ian; Nicol, Marcus; Donnan, Geoffrey A.; Patrick, Ian; Dewey, Helen M

doi:10.1161/01.str.0000254528.17405.cc

Cited by 135 publications

(160 citation statements)

References 16 publications

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“…Findings of Mosley and Zhang et al showed that 44% and 39.5% of patients were serviced by EMS. Our result was greatly lower than other similar studies [45,46]. Low utilization of EMS in Arak is the result of weak public awareness about critical time for stroke treatment and lack of trust to EMS.…”

Section: Discussioncontrasting

confidence: 86%

Assessment of Stroke Patients’ Status and Their Transfer Time by Emergency Medical Services to Valiasr Hospital in Arak City, Iran

Bahrampouri¹,

Khankeh²,

Dalvandi³

2016

HDQ

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Background: Stroke is a major cause of death and disability in the world and these complications can be decreased by competent emergency care. Emergency medical service (EMS) transfer half of the stroke patients to hospitals. This study aimed to determine diagnosis of status and transfer time of stroke patients by EMS to a main hospital (Valiasr) in Arak City. Materials and Methods:This study was a descriptive analytic study and conducted on 43 patients with a diagnosis of stroke that transferred by EMS to Valiasr Hospital in Arak City. Data were collected through a checklist which contained information about age, sex, type of accident, response time, scene time, transfer time, and total time from inpatients records and Emergency Center statistics. Regarding data analysis, descriptive statistical tests were performed by SPSS 19. Results:The mean(SD) age of patients was 73.7(3.8) years and 51.2% of them were women. The stroke diagnosis by EMS technicians was correct in 15(34.9%) cases. In 20(46.5%) cases, the diagnosis was wrong and in 8(18.6%) cases, there were not any diagnosis. The most common non-stroke condition was confusion. The mean response time and arrival time to location, transfer time, and total time were 6.9, 16.9, 9.1, and 35.3 minutes, respectively. In patients with correct diagnosis and wrong or no diagnosis, these mean times were 7, 17.1, 3.9, and 35.7 minutes and 6.9, 16.8, 9.7, and 33.5 minutes, respectively. Conclusion:The results of this study showed that an accurate diagnosis by EMS technicians could be an indicator for faster transfer of the patient to treatment center. It is recommended that more appropriate pre-hospital diagnosis tools of stroke be developed and handed to EMS staff, for more accurate diagnosis of strokes and their better treatment.

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Section: Discussioncontrasting

confidence: 86%

Assessment of Stroke Patients’ Status and Their Transfer Time by Emergency Medical Services to Valiasr Hospital in Arak City, Iran

Bahrampouri¹,

Khankeh²,

Dalvandi³

2016

HDQ

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“…30 Similar to the findings of this phase, it has also been reported that speech problems were associated with a correct ambulance diagnosis of stroke. 20 Speech problems also affect the speed of response by the public: a rapid call (within 1 hour) to the EMSs was found to be more likely when speech problems were present. 20 The association between speech problems and stroke would clearly be important to include in any training package.…”

Section: Discussionmentioning

confidence: 99%

Emergency Stroke Calls: Obtaining Rapid Telephone Triage (ESCORTT) – a programme of research to facilitate recognition of stroke by emergency medical dispatchers

Watkins

Jones

Leathley

et al. 2014

Programme Grants for Applied Research

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BackgroundRapid access to emergency stroke care can reduce death and disability by enabling immediate provision of interventions such as thrombolysis, physiological monitoring and stabilisation. One of the ways that access to services can be facilitated is through emergency medical service (EMS) dispatchers. The sensitivity of EMS dispatchers for identifying stroke is < 50%. Studies have shown that activation of the EMSs is the single most important factor in the rapid triage and treatment of acute stroke patients.ObjectivesTo facilitate recognition of stroke by emergency medical dispatchers (EMDs).DesignAn eight-phase mixed-methods study. Phase 1: a retrospective cohort study exploring stroke diagnosis. Phase 2: semi-structured interviews exploring public and EMS interactions. Phases 3 and 4: a content analysis of 999 calls exploring the interaction between the public and EMDs. Phases 5–7: development and implementation of stroke-specific online training (based on phases 1–4). Phase 8: an interrupted time series exploring the impact of the online training.SettingOne ambulance service and four hospitals.ParticipantsPatients arriving at hospital by ambulance with stroke suspected somewhere on the stroke pathway (phases 1 and 8). Patients arriving at hospital by ambulance with a final diagnosis of stroke (phase 2). Calls to the EMSs relating to phase 1 patients (phases 3 and 4). EMDs (phase 7).InterventionsStroke-specific online training package, designed to improve recognition of stroke for EMDs.Main outcome measuresPhase 1: symptoms indicative of a final and dispatch diagnosis of stroke. Phase 2: factors involved in the decision to call the EMSs when stroke is suspected. Phases 3 and 4: keywords used by the public when describing stroke and non-stroke symptoms to EMDs. Phase 8: proportion of patients with a final diagnosis of stroke correctly dispatched as stroke by EMDs.ResultsPhase 1: for patients with a final diagnosis of stroke, facial weakness and speech problems were significantly associated with an EMD code of stroke. Phase 2: four factors were identified – perceived seriousness; seeking and receiving lay or professional advice; caller’s description of symptoms and emotional response to symptoms. Phases 3 and 4: mention of ‘stroke’ or one or more Face Arm Speech Test (FAST) items is much more common in stroke compared with non-stroke calls. Consciousness level was often difficult for callers to determine and/or communicate. Phase 8: there was a significant difference (p = 0.003) in proportions correctly dispatched as stroke – before the training was implemented 58 out of 92 (63%); during implementation of training 42 out of 48 (88%); and after training implemented 47 out of 59 (80%).ConclusionsEMDs should be aware that callers are likely to describe loss of function (e.g. unable to grip) rather than symptoms (e.g. weakness) and that callers using the word ‘stroke’ or describing facial weakness, limb weakness or speech problems are likely to be calling about a stroke. Ambiguities and contradictions in dialogue about consciousness level arise during ambulance calls for suspected and confirmed stroke. The online training package improved recognition of stroke by EMDs. Recommendations for future research include testing the effectiveness of the Emergency Stroke Calls: Obtaining Rapid Telephone Triage (ESCORTT) training package on the recognition of stroke across other EMSs in England; and exploring the impact of the early identification of stroke by call handlers on patient and process outcomes.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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“…In addition, educational programs and campaigns to raise awareness of stroke symptoms and the importance of immediate consultation can aid in improving the number of patients being evaluated during the reperfusion window, and thus increase the number of rtPA-treated patients in MIC. [12,13] In contrast to thrombolysis management of ischemic stroke, MIC hospitals had more evidence of stroke care focused on intracerebral hemorrhage (ICH) management, including local clinical pathways and on-site neurosurgical availability. This probably reflects the high prevalence of ICH int MIC hospitals which were located in Asia, [14] but does confirm the ability of implementing care pathways similar to ischemic stroke.…”

Section: -Discussionmentioning

confidence: 99%