Abstract
Background: Hospital system identified decline in Emergency Medical Services arrivals [EMS-A] and increased Private Vehicle arrivals [PVA]. Purpose: Understand community response and PVA for focused education to increase EMS-A in order to improve treatment rates and decrease disability. Methods: Retrospective chart review to evaluate age, gender, race, poverty levels, stroke type, severity, treatment rates, and outcomes of the Target Population [TP]. Results: Review of 4,264 records [2015-2018] identified 1,612 PVA and 2,652 EMS-A. The largest PVA age group, identified as TP, was age 46-65. The TP was 60% male. Hispanics comprised 59% PVA versus [v] 54% EMS-A. All other races had higher EMS-A. Those with PVA were more likely to have private insurance [39% PVA v 23% EMS-A] and more likely to have zip codes with less than 10% poverty [8% PVA v 1% EMS-A]. Those below poverty had lower PVA [6% PVA v 12% EMS-A]. Stroke type was 90% Ischemic. Eighty-nine percent of PVA had NIHSS 0-7 [NIHSS: 0=24%, 1-5=57%, 6-7=8%]. Time last known well [TLKW] for PVA NIHSS 0-7 was less than or equal to 3.5 hours in 15% and greater than 3.5 hours in 33%. Alteplase treatment rate for NIHSS 0-7 was 4% PVA v 9% EMS-A. Mechanical Endovascular Reperfusion [MER] treatment rate for NIHSS 0-7 was 0% PVA v 1% EMS-A. Discharge [DC] disposition for PVA NIHSS 0-7 showed 21% rehabilitation and 2% death or hospice. DC Modified Rankin Scale [mRS] for PVA NIHSS 0-7 was mRS 2-3 in 17% and mRS 4-5 in 10%. Conclusion: The majority of PVA were middle aged [46-65] and predominantly male. Hispanics were the only ethnic group with higher PVA v EMS-A. The TP majority lived in areas with less than 10% poverty, had private insurance, had ischemic strokes with milder deficits and presented outside the Alteplase treatment window. Treatment rates for Alteplase and MER were 50% greater for NIHSS 0-7 for EMS-A. At DC, 21% PVA with NIHSS 0-7 required rehabilitation and 27% had slight to severe disability. Identifying characteristics of the TP is helpful for focused public education to increase EMS-A and early presentation regardless of severity to increase treatment rates and decrease disability.
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