EMS Can Beat the Clock When Stroke Strikes

Stroke patients who use EMS get treatment faster than those who do not take ambulance

(RxWiki News) If you have a stroke, you need to get to a hospital fast and receive therapy that will minimize damage to the brain. An ambulance may be quickest, but not all patients are calling EMS for help.

May is Stroke Awareness Month, and the American Heart Association/American Stroke Association wants everyone to know that time is of the essence when it comes to stroke. Clot-dissolving therapy should be administered within 60 minutes of hospital arrival.

A new study has shown that stroke patients who use emergency medical services (EMS) may get treatment faster, but one in three stroke emergencies did not use EMS.

"If you have signs of stroke, call 9-1-1 immediately."

James Ekundayo, MD, lead author of the study and assistant professor in the Department of Family and Community Medicine at Meharry Medical College in Nashville, Tennessee, reviewed records of more than 204,000 stroke patients arriving at emergency rooms at 1,563 hospitals between 2003 and 2010.

A stroke happens when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts.

Dr. Ekundayo and his fellow scientists discovered that two-thirds of stroke patients arrived by EMS, with the rest arriving in other ways. EMS transported almost eight in 10 of those who got to the hospital within two hours of the start of their stroke symptoms.

Almost 61 percent of people transported by EMS got to the hospital within three hours of the first symptoms, compared to 40 percent of those who did not use EMS.

The investigators also noted that almost 55 percent of those using EMS had a brain scan within 25 minutes of hospital arrival, compared to 36 percent of those who did not use EMS.

Of patients eligible for a clot-busting medication, 67 percent of those using EMS received a clot-buster within three hours of symptom onset, compared to 44 percent of those who did not use EMS.

Patients who are eligible to receive the clot-dissolving medication recombinant tissue plasminogen activator (tPA) must receive it within three to 4.5 hours of symptom onset to have the best opportunity for benefit, according to the American Heart Association. They should receive medication within 60 minutes of hospital arrival.

“EMS are able to give the hospital a heads up, and that grabs the attention of the emergency room staff to be ready to act as soon as the patient arrives,” said Jeffrey Saver, MD, senior author of the study and director of the UCLA Comprehensive Stroke Center in Los Angeles. “The ambulance crew also knows which hospitals in the area have qualified stroke centers. Patients don't lose time going to one hospital only to be referred to another that can provide more advanced care if needed.”

Minorities and rural residents were less likely to call for EMS at the signs of a stroke, the investigators observed.

Chris Galloway, MD, dailyRx medical editor and Contributing Expert said "In stroke care, time is brain.  The sooner a patient can reach definitive medical management, the better the outcome likely will be.  Activating the EMS system not only gets you in front of the doctor faster, but to the most appropriate ER that specializes in acute stroke care."

“A number of factors can fuel the reluctance to call 9-1-1,” said Dr. Ekundayo. “People may not recognize symptoms and may delay seeking medical care or call their doctor instead. We hear people say they just didn’t want to be a bother, but many times there could have been a better outcome if EMS had been called.”

To recognize symptoms of stroke, the American Heart Association/American Stroke Association suggests using an easy-to-remember system called F.A.S.T.:

  • Face drooping: Does one side of the face droop or is it numb?
  • Arm weakness: Is one arm weak or numb?
  • Speech difficulty: Is speech slurred, are you unable to speak, or are you hard to understand?
  • Time to call 9-1-1: If you have any of these symptoms, even if the symptoms go away, call 9-1-1 and get to the hospital immediately.

“Your life, your brain, depends on calling 9-1-1,” Dr. Saver said. “Know the signs and act fast if you or someone you’re with is having stroke symptoms.”

This study was published at the end of April in Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal.

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Review Date: 
May 6, 2013