Abstract TP256: Ems Run Times by Weekday vs. Weekend For Stroke Patients in San Diego County

Abstract

Background: Emergency Medical Services (EMS) is important as the initial responder, very little data examines EMS response and transport to hospital diagnosis. Understanding differences between weekday and weekend is informative for resource and staff planning. Using a countywide registry, we evaluated differences in EMS response times on weekdays and weekends and in-hospital treatment. Methods: We included EMS San Diego County Stroke Registry cases with a computer automated dispatch (CAD) and base hospital record (BHR) from July 2017 through December 2018; linked on EMS incident number. We analyzed EMS response, scene and transport time by weekday and weekend for all cases and cases with last known normal (LKN) to EMS enroute time < 6 hours. Hospital arrival to tPA and to embolectomy therapy (EVT) time was analyzed for this subgroup. Weekend was defined as Friday 1800 through Monday 0600. Results: Of 2,376 cases, 726 (30.6%) arrived during weekends. Weekend mean (±SD) response time was 6.7 (±3.4) minutes (min); 7.1 min (±3.9) on weekdays. Mean weekend scene time was 12.8 (±5.1) min, 13.2 (±5.3) min on weekdays (p=.18). Transport time was 13.2 (±7.6) min on weekends, 14.1 (±7.8) min on weekdays (p=.01). There were 1,190 cases with LKN to EMS enroute time < 6 hours, 379 arrived on weekends (31.8%). Mean (±SD) response time was 6.6 (±3.4) min on weekends, 7.2 (±3.9) min on weekdays; weekend scene time 12.1 (±4.5) min, weekday scene time 12.2 (±4.9); weekend transport time 12.2 (±6.6) min, weekday transport time 12.7 (±7.4) min. Of this group, 378 received tPA, 126 (33.3%) on the weekend. Mean (±SD) weekend arrival to tPA was 53.6 (±22.2) min; 56.0 (±32.1) min on weekdays (p=.39). 100 cases received EVT, 39 on a weekend. Mean (±SD) weekend arrival to EVT was 2.1 (±0.6) hours; weekdays 1.9 (±0.8) hours (p=.13). Conclusion: One in three patients arrived at the hospital on weekends. EMS response time and scene time did not differ, while transport time on the weekend was shorter, although this may not be clinically significant. This may be attributed to traffic volume and patterns during these times. However, among patients with shorter LKN time and patients receiving tPA no difference in EMS times was seen. Overall acute stroke transfer times did not differ across weekends and weekdays.