Emergency Medical Services Capacity for Prehospital Care of Stroke Patients in North Carolina

Patel, Mehul

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March 19, 2019

Creator

Patel, Mehul
- Affiliation: Gillings School of Global Public Health, Department of Epidemiology

Abstract

An acute stroke requires immediate medical attention. Emergency medical services (EMS) can positively impact acute stroke patients through early identification and expedited transport to specialized acute care facilities. However, EMS systems are not equally qualified and prepared to respond to, evaluate, and manage stroke patients in a timely manner. The aims of this dissertation were twofold. First, the capacity of EMS systems in North Carolina (NC) for prehospital stroke care was assessed. Education of EMS personnel on stroke should continue to be an area of focus, particularly the frequency and content of trainings. Significant progress has been made in prehospital stroke care in NC, specifically with the use of standardized patient care protocols, validated scales and screening tools, destination plans, and advance notification policies. However, improvements in the use of stroke destination plans and communication of stroke screen results remain to be realized. Overall deficiencies in EMS stroke care capacity were observed regardless of system patient volume and population density. Secondly, prehospital time intervals for EMS responses to patients suspected of having a stroke were evaluated. While national consensus guidelines recommend EMS responds to a stroke patient in 9 minutes and spends no more than 15 minutes at the scene before transport, almost half of suspected stroke events took longer than recommended in NC in 2009-2010. EMS units that responded with lights and sirens were associated with shorter time intervals, suggesting that a greater sense of urgency leads to expedited responses. Furthermore, EMS systems that included specific instructions in their stroke protocols to limit scene time were associated with significantly shorter time units spent at the scene with a suspected stroke patient. Prehospital stroke care requires continuous monitoring and quality improvement efforts at the system and personnel levels. This dissertation identified areas of system capacity in need of improvement and evaluated predictors of prehospital delays in NC. Other regions in the United States could similarly assess their stroke experiences using these tools. Finally, further study of the impact of EMS stroke care on emergency department and hospital processes are warranted.

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