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| EMS responses and acute stroke care prompt in poor areas |
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11 May 2006
FFor people experiencing a stroke, living in a poor community does not appear to influence emergency medical services' (EMS) response times, investigators report. However, stroke victims or their families may be too reluctant to call 911 for emergency services when symptoms start.
Dr Dawn Kleindorfer and associates at the University of Cincinnati College of Medicine in Ohio theorised that socioeconomic status (SES) would affect emergency response time, because of such issues as the need for a police escort in high crime areas, traffic congestion, overcrowded emergency departments (EDs) and tall public housing buildings with nonworking elevators. They examined the association between a community's SES and the time intervals between a 911 call and arrival in the ED among patients with stroke. Their findings are reported in the rapid access online issue of Stroke: Journal of the American Heart Association.
The area studied was the Greater Cincinnati metropolitan region, served by 18 hospitals and a single group of stroke-team physicians. SES among the 1.3 million residents varies widely, from extremely wealthy areas to areas with >70% of the people living in poverty. Subjects with stroke were included if their stroke occurred between January 1 and December 31, 1999 in their own homes. EMS on-scene time and ED arrival time were documented. The SES of each community was based on data from the 2000 US Census Bureau website.
During the study period, 3814 stroke and TIA patients were hospitalised. Only 38.8% of the subjects called 911. Among that subgroup, the mean time between the call and arrival on-scene was 6.5 minutes, on-scene time was 14.1 minutes, and transport time was 13.1 minutes. The poorest SES neighbourhoods experienced slightly longer time for EMS teams to reach the patient and to travel to the ED. But less time was spent on the scene in the poorer communities, so SES had no clinically significant impact on the overall EMS response time from the 911 call to arrival at the ED.
The delay related to patient or family recognition of stroke symptoms, and limited use of 911 services, are likely much more important, on average, than delays that occur because of EMS systems and providers. The team suggests that "public education efforts should not only focus on stroke warning signs, but they must also include the idea that patients should call 911 right away once these symptoms occur.
Reference:
Stroke 2006; 37 (6): 1518-1513.
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