J Korean Neurol Assoc.  2011 May;29(2):89-94.

Prehospital Delay Factors After Stroke and Paramedic Identification of Stroke Patients in a Metropolitan City Emergency Medical Service System

• Kim HJ
• Kim DH
• Park HI
• Lee IY
• Cha JK

Abstract

BACKGROUND
Accurate recognition of stroke victims by ambulance paramedics is necessary to ensure the rapid transfer of these patients to the hospital. We carried out a prospective study to characterize the cause of prehospital delays after stroke by the emergency medical service (EMS) and to determine the accuracy of identifying acute stroke by paramedics.
METHODS
All paramedics in the Busan Metropolitan 119 EMS were asked to record the clinical presentations and time intervals from symptom onset to various points along the patients' prehospital course on the ambulance admission sheets for suspected stroke patients during a month (February 1, 2010 to February 28, 2010). Neurologists in twenty four hospitals reviewed the hospital records for the patients who were given a diagnosis of stroke or transient ischemic attack by the paramedics.
RESULTS
Of the EMS on-scene evaluations, the diagnosis of stroke by ambulance paramedics was correct for 79 of the 186 (43%) patients. Positive predictive values for main suspected stroke symptoms were 95% in hemiparesis, 88% in speech disturbance and 44% in impaired consciousness. The prehospital personnel transferred the suspected stroke patients to each hospital at a mean of 25 minutes after the emergency 119 call. However, only 62% of the stroke patients called EMS within the first 2 hours of stroke.
CONCLUSIONS
Public education for the need to seek EMS promptly after stroke as a medical emergency, and strokespecific training for EMS personnel are essential so that stroke patients receive effective acute treatment.

Keyword

Stroke recognition; Emergency medical service; Prehospital delay; Paramedics

MeSH Terms

Allied Health Personnel
Ambulances
Consciousness
Dietary Sucrose
Emergencies
Emergency Medical Services
Hospital Records
Humans
Ischemic Attack, Transient
Paresis
Prospective Studies
Stroke
Dietary Sucrose