Abstract WP303: Laying the Groundwork for Stroke Care in Armenia. Assessment of Ambulance Services in the Republic of Armenia: Current State of Care, Public Perception and Opportunities for Strengthening the Emergency Medical System

Abstract

Background: The recent creation of the Armenian National Stroke Program has stipulated that all links in the Stroke Chain of Survival are examined and remediated including Emergency Medical Systems (EMS). EMS forms the second link in the chain of survival after early recognition of stroke symptoms by the general public. This study describes the perception of and performance of EMS in Armenia’s capital, Yerevan, and provides the groundwork for nascent stroke care in Armenia. Methods: We used mixed methods to derive a comprehensive picture of the state of Emergency Medical Systems. We administered a survey using random digit telephone number generator to 384 households at three intervals over a 5 year period in 2005, 2009 and 2010. A trend analysis was performed for six questions regarding EMS. We queried knowledge of the 911-equivalent access number, perception of accessibility of emergency services, perception of anticipated care, and financial concerns. The surveys had a 96% response rate. We also performed key stakeholder interviews and focus groups to describe the state and evolution of emergency care in Armenia. Results and Discussion: Appropriate and timely stroke care relies on activation of EMS. EMS in Armenia remains an ambulance-based service following the Franco-German model where ambulances are staffed by a physician, nurse and driver. Utilization of EMS in Armenia is one of the highest in the world. Eighty percent of calls are treated on scene and 20% are transported to surrounding hospitals. There is currently minimal hospital-based emergency care. Over the three survey periods there was a trend towards increased trust in the EMS system. The idea that the ambulance will respond in a timely manner and not request payment before accepting the call (p=0.04) gained traction. Increased trust means more people will wait for the ambulance than drive the patient to the hospital themselves (p=0.01), a key factor for prompt stroke care. Since February of 2019, stroke patients are transferred to two stroke referral centers in Yerevan. EMS systems strengthening starting with public education and trust-building, emergency medicine residency, ambulance and helicopter protocols and tele-stroke development is key in providing timely and quality stroke care.