Abstract WP252: EMS Use After Acute Ischemic Stroke in Korean Population: Familyism may not Help

Abstract

Introduction: Acute ischemic stroke (AIS) is a leading cause of mortality and disability, and many die before reaching to a hospital or in an emergency department in Korea. Emergency medical services (EMS) play a pivotal role in optimizing survival rate by providing onsite treatment and speedy transportation of patients. Yet, many fail to use EMS, and subsequently, fail to receive a reperfusion therapy within the time window. This study aimed to identify factors associated with the EMS use. Hypothesis: We hypothesize that among AIS patients, (1) EMS use will shorten the pre-hospital delay time; (2) patients’ living condition (living alone, living in rural area) and presence of noticeable symptoms will be associated with EMS use; (3) familyism will influence the decision on health and EMS use among AIS patients. Methods: 160 consecutive patients participated to a structured interview. Decision time, transportation time and the overall pre-hospital delay time were compared between EMS- and other transportation-users. Patients’ living condition, history of stroke, symptom experience, first contacted person for a decision making were examined for the association with EMS use. Results: Only 30.9% used an EMS. Both decision time (median 120 vs. 480 min., p= 0.002) and the overall pre-hospital delay time (median 140 vs. 625 min., p= 0.004) were significantly shorter in EMS users than other transportation users. EMS use was associated with the presence of hemiparesis ( p=0.003 ), first contacted person at the presence of symptoms ( p=0.032 ), and was inversely associated with failure to recognize the urgency of symptoms ( p =0.006). A logistic regression revealed that presence of hemiparesis ( p=0.014 ), recognizing the symptom’s urgency predicted the use of EMS ( p =0.033). Conclusion: While EMS was underutilized by stroke patients, neither living with family nor living in urban area played a positive role in EMS use. Familyism-based cultural norm of contacting adult children in a crisis did not favorably contribute to the EMS use nor to early arrival at the hospital. Failure to recognize urgency was a prominent barrier to EMS use, and that warrants more targeted education for people at risk of a new or a recurrent stroke to improve EMS use and better outcomes.