Abstract 170: Paramedic-Suspected Stroke Increased after Implementing a Community-Engaged Stroke Preparedness Intervention in Chicago

Abstract

Introduction: Emergency medical services (EMS) utilization for acute stroke is associated with improved stroke care and outcomes. We evaluated whether a community-engaged stroke preparedness intervention would increase EMS use for suspected stroke. Methods: The Community Engagement for Early Recognition and Immediate Action in Stroke (CEERIAS) study was conducted in a South Side Chicago neighborhood with proximity to a primary stroke center. In early 2016, CEERIAS implemented a community-engaged stroke preparedness intervention delivered by trained laypersons from the target community who taught peers about the importance of calling 9-1-1 for acute stroke. Paramedic impressions of all EMS calls were obtained from the municipal EMS provider agency serving the study neighborhood. Using ArcGIS 10.5.1 and ArcGIS Pro 2.1.2 (Esri Inc., Redlands, CA), EMS run locations were geolocated, and Getis-Ord Gi* analysis was used to identify hot spots for EMS-suspected stroke. Statistical hot and cold spots are defined as areas where there is <1% chance of case clusters occurring by chance. Results: A total of 274,773 EMS runs were successfully geolocated in the 13.5 month pre-CEERIAS intervention period, and 267,061 in the 12.5 month post-CEERIAS intervention period. The study hospital’s neighborhood changed from a cold spot to a hot spot for EMS-suspected stroke (Figure). In the hot spot region adjacent to the study hospital, EMS use for suspected stroke increased 2.2-fold (p<0.001) post-CEERIAS compared to pre-CEERIAS. Overall EMS utilization and EMS utilization for stroke were similar pre- and post-CEERIAS elsewhere in the city. Conclusions: A community-engaged stroke preparedness intervention was associated with an increase in EMS use for suspected stroke in targeted neighborhoods of Chicago. Further studies should investigate the effect on stroke outcomes and dissemination strategies to broaden the impact of this intervention.