Abstract T P186: "I Think It's a Stroke" - An Analysis of 9-1-1 Calls

Abstract

Background and objective: Immediate access to emergency medical services (EMS) is critical in stroke. Correct dispatcher diagnosis may be influenced by caller recognition of stroke symptoms. In a study of 9-1-1 calls, we hypothesized that the word "stroke" is infrequently used by EMS callers when reporting strokes. Methods: From 3 hospitals, we identified 62 patients with confirmed stroke who arrived by EMS during the period of January - June 2013 and analyzed the 9-1-1 audio recordings. We used an evaluation form to identify words used to describe stroke symptoms by the callers. We compared the association between dispatcher diagnosis and caller use of “stroke” and call duration between those that used “stroke” versus to those that did not. Results: Of the 62 patients in the study, "stroke" was mentioned by 20 (32.3%) callers. The average duration of 9-1-1 calls was 55 seconds (IQR 40-78 seconds) and did not differ in calls that used “stroke” vs. those that did not (56 vs. 54 seconds; p=0.47). The dispatcher suspected stroke in 20 cases (32.3%) of which 18 were instances where the caller used the word “stroke” (p<0.001); in 2 cases, the caller used “stroke” and dispatcher did not while in 2 others the dispatcher suspected stroke but the caller did not. Other symptoms reported were altered consciousness/confusion (24.2%), sudden weakness (22.6%), fall (17.7%), speech disturbance (16.2%), difficulty in balance or dizziness (16.2%), and numbness (11.3%). Atypical symptoms like chest pain, backache, depression, erratic heartbeat, and abdominal pain were noted by 27.4% of callers. Weakness (p=0.048) was significantly associated with use of “stroke” while altered consciousness/confusion (p=0.006) and atypical symptoms (p=0.047) were more common in calls that did not mention “stroke”. Conclusion: The word "stroke" was used by only one-third of the EMS callers. The most common reported symptom that correlated with use of the word “stroke” was weakness. Use of the word “stroke” by callers was strongly associated with dispatcher diagnosis of stroke. Effective educational intervention with emphasis on communicating stroke symptoms and indicating stroke may help facilitate immediate and correct action by the EMS.