03 May Patterns of Emergency Medical Services Use and Its Association With Timely Stroke Treatment: Findings From Get With the Guidelines-Stroke

Posted at 23:13h in Author Interviews, Emergency Care, Stroke by

MedicalResearch.com eInterview with with Dr. O. James Ekundayo, MD, DrPH

Assistant Professor
Department of Family & Community Medicine
Meharry Medical College 1005 Dr. D.B. Todd Jr. Blvd.
Nashville, TN 37208

Written Interview conducted with author by Editor Marie Benz, MD

MedicalResearch.com What are the main findings of the study?

Answer: The key findings are:

·         One third of stroke patients did not activate Emergency Medical Services (EMS).

·         Subgroups of patients who were less likely to use EMS include younger patients, patients of minority race or ethnicity, and those living in rural communities.

·         Prior history of stroke /TIA does not confer greater likelihood of EMS activation during subsequent stroke.

·         Patients who used EMS had shorter pre-hospital and in-hospital delay. They arrived early, had prompter evaluation, and received more rapid treatment.

·         More patients, who were eligible for clot-busting drug, received them.

These happened because EMS gives the receiving hospital pre-notification about the arrival of the patient and the ER staff is ready to act as soon as the patient arrives.

MedicalResearch.com: Were any of the findings unexpected?

Answer: Unexpected findings include:

  • Suboptimal use of EMS by stroke patients, in spite of public outreach efforts.
  • The lack of association of previous history of stroke or TIA with greater likelihood of EMS activation during subsequent stroke, indicating potential missed opportunities to educate stroke or TIA patients on the need for EMS transportation at future symptom onset.

MedicalResearch.com: What should clinicians and patients take away from your report?

 Answer:

  • Although EMS use is independently associated with more rapid evaluation and treatment of stroke, about one third of stroke patients fail to use EMS. Young people, minorities, and rural residents were less likely to call for EMS at the signs of a stroke. The take home message is that, these groups should be the target of interventions to improve EMS activation in stroke.
  • Also, clinicians should adhere to discharge recommendations for stroke patients including warning signs for stroke and the need to activate EMS at the onset of symptoms.

MedicalResearch.com What recommendations do you have for future research as a result of this study?

Answer:

  • We will want to address reasons for disparities in EMS use. Particularly if system mistrust is a contributory factor.

Citation:

Patterns of Emergency Medical Services Use and Its Association With Timely Stroke Treatment: Findings From Get With the Guidelines-Stroke

Olaniyi James Ekundayo, Jeffrey L. Saver, Gregg C. Fonarow, Lee H. Schwamm,
Ying Xian, Xin Zhao, Adrian F. Hernandez, Eric D. Peterson, and Eric M. Cheng

Circ Cardiovasc Qual Outcomes. 2013;
published online before print April 29 2013, doi:10.1161/CIRCOUTCOMES.113.000089

Last Updated on May 3, 2013 by Marie Benz MD FAAD

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