Eswaradass Prasanna Venkatesan, Swartz Richard H, Rosen Jamey, Hill Michael D, Lindsay M Patrice
Affiliations: Calgary Stroke Program (Eswaradass, Hill), Department of Clinical Neurosciences, Cumming School of Medicine; Departments of Radiology (Hill), Community Health Sciences (Hill) and Medicine (Hill), Cumming School of Medicine, University of Calgary; Hotchkiss Brain Institute (Hill), Calgary, Alta.; Heart and Stroke Foundation (Lindsay), Ottawa, Ont.; Neurology Division (Swartz), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Geosyntec Consultants (Rosen), Guelph, Ont.
CMAJ Open. 2017 Jun 14;5(2):E454-E459. doi: 10.9778/cmajo.20160166.
Canada's vast geography creates challenges for ensuring prompt transport to hospital of patients who have had a stroke. We sought to determine the proportion of people across various Canadian provinces for whom hyperacute stroke services are accessible within evidence-based time targets.
We calculated, for the 8 provinces with available data, drive-time polygons on a map of Canada that delineated the area around stroke centres and emergency medical services (EMS) base centres to which one can drive in 3.5-6 hours. We calculated the proportional area of each forward sortation area (first 3 digits of the postal code) contained within a drive-time polygon. We applied this ratio to the 2011 Canadian census population of the forward sortation area to estimate the population that can reach a stroke centre in a designated time.
A total of 47.1%-96.4% of Canadians live within a 4.5-hour drive to a stroke centre via road EMS, and 53.3%-96.8% live within a 6-hour drive. Assuming a total travel time of 5 hours by EMS from base centre to patient and patient to hospital, 84.7%-99.8% of the population has access to a current or proposed endovascular thrombectomy site.
Most Canadians live within 6 hours' road access to a stroke centre. Geospatial mapping could be used to inform decisions for additional sites and identify gaps in service accessibility. Coordinated systems of care and ambulance bypass agreements must continue to evolve to ensure maximal access to time-sensitive emergency stroke services.
加拿大地域辽阔，这给确保中风患者能迅速被送往医院带来了挑战。我们试图确定加拿大各省中能在基于证据的时间目标内获得超急性中风服务的人群比例。
对于有可用数据的8个省份，我们在加拿大地图上计算了驾车时间多边形，该多边形划定了中风中心和紧急医疗服务（EMS）基地中心周围3.5至6小时车程可达的区域。我们计算了每个前向分拣区（邮政编码的前3位数字）在驾车时间多边形内所占的比例面积。我们将这个比例应用于2011年加拿大前向分拣区的人口普查数据，以估计在指定时间内能够到达中风中心的人口数量。
共有47.1% - 96.4%的加拿大人通过公路EMS在4.5小时车程内可到达中风中心，53.3% - 96.8%的加拿大人在6小时车程内可到达。假设EMS从基地中心到患者以及患者到医院的总行程时间为5小时，84.7% - 99.8%的人口能够到达当前或拟议的血管内血栓切除术地点。
大多数加拿大人居住在距离中风中心6小时车程以内的地方。地理空间映射可用于为增设地点的决策提供信息，并识别服务可及性方面的差距。必须持续发展协调的护理系统和救护车绕行协议，以确保最大程度地获得对时间敏感的紧急中风服务。
