Department of Emergency Medicine, Massachusetts General Hospital, Boston (R.E.C., K.M.B., C.A.C., K.S.Z.).
Harvard Medical School, Boston, MA (R.E.C., C.A.C., K.S.Z.).
Stroke. 2022 Mar;53(3):e75-e78. doi: 10.1161/STROKEAHA.121.037509. Epub 2022 Feb 3.
Optimal care for patients with stroke relies on timely recognition and rapid transport to appropriate treatment, often by emergency medical services (EMS). Our primary objective was to describe EMS time intervals for patients with suspected stroke in the United States. We also sought to quantify the variation in EMS time intervals by geographic location and urbanicity.
We conducted a cross-sectional evaluation of EMS 9-1-1 activations (ie, calls for service) included in the 2018 and 2019 National EMS Information System datasets. We included ground or air EMS activations for a 9-1-1 scene response where a patient aged ≥18 years with suspected stroke was treated and transported by EMS. Time intervals for dispatch, response, scene, transport, and total prehospital time (ie, from dispatch to hospital arrival) were calculated, stratified by ground and air transport type.
A total of 410 187 activations for suspected stroke were included, of which 98% were a ground transport. The median total prehospital time for ground transports was 35 minutes (interquartile range, 27-45, 90th percentile 58). Median total prehospital time for air transports was substantially longer at 56 minutes (interquartile range, 43-70, 90th percentile 86). Times varied by Census division and urbanicity with the shortest ground total prehospital times in the East North Central division and urban areas and longest times in the East South Central and rural and frontier areas.
Timely EMS response and transport is critical for optimizing care of patients with suspected stroke. Using a large, national dataset of EMS activations, we found variations by geographic location and urbanicity in total prehospital time for ground and air EMS activations for patients with stroke.
为了为中风患者提供最佳护理，需要及时识别并迅速将其送往适当的治疗机构，通常由紧急医疗服务（EMS）来完成。我们的主要目标是描述美国疑似中风患者的 EMS 时间间隔。我们还试图量化地理区域和城市人口密度对 EMS 时间间隔的影响。
我们对 2018 年和 2019 年国家 EMS 信息系统数据集内的 EMS 9-1-1 激活（即服务请求）进行了横断面评估。我们纳入了地面或空中 EMS 激活，这些激活是在对 9-1-1 现场响应中进行的，现场有一名年龄≥18 岁的疑似中风患者接受了 EMS 的治疗和转运。计算了派遣、响应、现场、转运和总院前时间（即从派遣到到达医院）的时间间隔，并按地面和空中转运类型进行分层。
共纳入了 410187 例疑似中风的激活，其中 98%为地面转运。地面转运的总院前时间中位数为 35 分钟（四分位距 27-45，90 百分位数为 58）。空中转运的总院前时间中位数要长得多，为 56 分钟（四分位距 43-70，90 百分位数为 86）。时间因人口普查分区和城市人口密度而异，东部中北部分区和城市地区的地面总院前时间最短，而东部中南部和农村及边远地区的时间最长。
及时的 EMS 响应和转运对优化疑似中风患者的护理至关重要。使用大型全国性 EMS 激活数据集，我们发现，地面和空中 EMS 转运的总院前时间因地理位置和城市人口密度而异。
