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

J Korean Neurol Assoc > Volume 29(2); 2011 > Article

Journal of the Korean Neurological Association 2011;29(2): 89-94.

일개 광역시 응급의료서비스에서 뇌졸중 후 병원도착 전 단계의 지연 요인과 구급대원의 뇌졸중 환자 식별

김해종, 김대현a,b 박향이a 이인영c 차재관a,b

동아대학교 의과대학 신경과학교실a, 부산울산 권역별 심뇌혈관센터b, 부산광역시 소방본부c

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

Hae-Jong Kim

Department of Neurologya, Dong-A University College of Medicine, Busan, Korea Busan-Ulsan Regional Cardiocerebrovascular Centerb, Busan, Korea Busan Fire Departmentc, Busan, Korea

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 stroke- specific training for EMS personnel are essential so that stroke patients receive effective acute treatment. KeyWords:Stroke recognition, Emergency medical service, Prehospital delay, Paramedics