Abstract
BackgroundStroke is a time-dependent medical emergency in which early presentation to specialist care reduces death and dependency. Up to 70% of all stroke patients obtain first medical contact from the Emergency Medical Services (EMS). Identifying ‘true stroke’ from an EMS call is challenging, with over 50% of strokes being misclassified. The aim of this study was to evaluate the impact of the training package on the recognition of stroke by Emergency Medical Dispatchers (EMDs).MethodsThis study took place in an ambulance service and a hospital in England using an interrupted time-series design. Suspected stroke patients were identified in one week blocks, every three weeks over an 18 month period, during which time the training was implemented. Patients were included if they had a diagnosis of stroke (EMS or hospital). The effect of the intervention on the accuracy of dispatch diagnosis was investigated using binomial (grouped) logistic regression.ResultsIn the Pre-implementation period EMDs correctly identified 63% of stroke patients; this increased to 80% Post-implementation. This change was significant (p=0.003), reflecting an improvement in identifying stroke patients relative to the Pre-implementation period both the During-implementation (OR=4.10 [95% CI 1.58 to 10.66]) and Post-implementation (OR=2.30 [95% CI 1.07 to 4.92]) periods. For patients with a final diagnosis of stroke who had been dispatched as stroke there was a marginally non-significant 2.8 minutes (95% CI −0.2 to 5.9 minutes, p=0.068) reduction between Pre- and Post-implementation periods from call to arrival of the ambulance at scene.ConclusionsThis is the first study to develop, implement and evaluate the impact of a training package for EMDs with the aim of improving the recognition of stroke. Training led to a significant increase in the proportion of stroke patients dispatched as such by EMDs; a small reduction in time from call to arrival at scene by the ambulance also appeared likely. The training package has been endorsed by the UK Stroke Forum Education and Training, and is free to access on-line.
Highlights
Stroke is a time-dependent medical emergency in which early presentation to specialist care reduces death and dependency
One way of facilitating rapid Emergency Medical Services (EMS) transport to hospital, thereby improving the chance for early presentation is through enhancing communication between Emergency Medical Dispatchers (EMDs) and the general public. Within this programme of research, we have previously explored the interaction between EMDs and the public during emergency calls for stroke, in order to inform the content of stroke-specific, on-line training for EMDs; this included exploring callers’ experiences [9] and identifying the key words used by the public to describe and that are indicative of stroke [10]
A final confirmed diagnosis was recorded for 427 patients, and of these 213 (50.2%) had a final diagnosis of stroke (Table 2)
Summary
Stroke is a time-dependent medical emergency in which early presentation to specialist care reduces death and dependency. Stroke is a leading cause of mortality and disability worldwide [1] and is increasingly recognised as a timedependent medical emergency in which early presentation to specialist care reduces death and dependency [2]. Up to 70% of all stroke patients obtain first medical contact from the Emergency Medical Services (EMS) [2,3,4]. Emergency Medical Dispatchers (EMDs) use this system to categorise ambulance response and decide on the level of medical care sent. If the EMD suspects a time critical condition such as stroke, an ambulance can be dispatched as a high priority (category A, currently up to a 19 minute response).
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