University of Central Lancashire, Preston, UK.
Int J Stroke. 2013 Aug;8(6):408-12. doi: 10.1111/j.1747-4949.2011.00749.x. Epub 2012 Feb 15.
Accurate dispatch of emergency medical services at the onset of acute stroke is vital in expediting assessment and treatment. We examined the relationship between callers' description of potential stroke symptoms to the emergency medical dispatcher and the subsequent classification and prioritisation of emergency medical services response.
To identify key 'indicator' words used by people making emergency calls for suspected stroke, comparing these with the subsequent category of response given by the emergency medical dispatcher.
A retrospective chart review (hospital and emergency medical services) in North West England (October 1, 2006 to September 30, 2007) identified digitally recorded emergency medical services calls, which related to patients who had a diagnosis of suspected stroke at some point on the stroke pathway (from the emergency medical services call taker through to final medical diagnosis). Using content analysis, words used to describe stroke by the caller were recorded. A second researcher independently followed the same procedure in order to produce a list of 'indicator' words. Description of stroke-specific and nonstroke-specific problems reported by the caller was compared with subsequent emergency medical services dispatch coding and demographic features.
Six hundred forty-three calls were made to emergency medical services of which 592 (92%) had complete emergency medical services and hospital data. The majority of callers were female (67%) and family members (55%). The most frequently reported problems first said by callers to the emergency medical dispatcher were collapse or fall (26%) and stroke (25%). Callers who identified that the patient was having a stroke were correct in 89% of cases. Calls were dispatched as stroke in 45% of cases, of which 83% had confirmed stroke. Of the first reported problems, Face Arm Speech Test stroke symptoms were mentioned in less than 5% of calls, with speech problems being the most common symptom. No callers mentioned all three Face Arm Speech Test symptoms.
Callers who contacted emergency medical services for suspected stroke and said stroke as the first reported problem were often correct. Calls categorised as stroke by the emergency medical dispatcher were commonly confirmed as stroke in the hospital. Speech problems were the most commonly reported element of the Face Arm Speech Test test to be reported by callers. Recognition of possible stroke diagnosis in fall and other presentations should be considered by emergency medical dispatchers. Further development and training are needed in the community to improve prehospital stroke recognition in order to expedite hyperacute stroke care.
在急性中风发作时准确派遣紧急医疗服务至关重要，这有助于加快评估和治疗。我们研究了呼叫者向紧急医疗调度员描述潜在中风症状与随后紧急医疗服务响应分类和优先排序之间的关系。
确定拨打疑似中风急救电话的人使用的关键“指示”词，并将这些词与紧急医疗调度员给出的后续响应类别进行比较。
在英格兰西北部进行回顾性图表审查（2006 年 10 月 1 日至 2007 年 9 月 30 日），确定与患者在中风途径上的某个点（从紧急医疗服务接听员到最终医学诊断）诊断为疑似中风的相关数字记录的紧急医疗服务电话。使用内容分析，记录呼叫者用来描述中风的词。第二位研究人员独立遵循相同的程序，以生成“指示”词列表。将呼叫者报告的中风特异性和非中风特异性问题的描述与随后的紧急医疗服务调度编码和人口统计学特征进行比较。
向紧急医疗服务部门拨打了 643 个电话，其中 592 个（92%）有完整的紧急医疗服务和医院数据。大多数呼叫者是女性（67%）和家庭成员（55%）。呼叫者首先向紧急医疗调度员报告的最常见问题是晕倒或摔倒（26%）和中风（25%）。呼叫者确定患者正在中风的准确率为 89%。有 45%的电话被调度为中风，其中 83%的电话被证实患有中风。在第一个报告的问题中，少于 5%的电话提到了简易脑卒中测试的脑卒中症状，言语问题是最常见的症状。没有呼叫者提到简易脑卒中测试的所有三个症状。
拨打疑似中风急救电话并将第一个报告的问题定为中风的呼叫者通常是正确的。紧急医疗调度员分类为中风的电话通常在医院被确认为中风。呼叫者报告的简易脑卒中测试中最常见的元素是言语问题。紧急医疗调度员应考虑在跌倒和其他表现中识别可能的中风诊断。需要在社区中进一步发展和培训，以提高院前脑卒中识别能力，从而加快超急性脑卒中护理。
