Abstract
Background
Thrombolysis improves stroke outcome, but efficacy of the treatment is limited by
time. Therefore, recognition of stroke symptoms by dispatch centres and by emergency
medical services (EMS) is crucial, as is minimization of pre-hospital delays. We investigated
the pre-hospital delays in patients with stroke treated with thrombolysis and compared
the delays between rural and urban patients.
Methods
Patients that had received thrombolysis at Oulu University Hospital (OUH) between
1 January 2013 and 31 December 2015 were identified. Patients were divided into urban
and rural based on the site of the EMS mission. Pre-hospital charts and medical records
were reviewed. Onset-to-dispatch, dispatch-to-arrival of EMS, on-scene, transport
and door-to-needle times were studied.
Results
Three hundred one stroke patients were treated with thrombolysis at OUH, and 232 of
them were included in the study. Positive Face Arm Speech Test (FAST) findings, priority
dispatch code and transport code were associated with shorter transport delays. The
priority dispatch was not used in 12.5% of stroke patients treated with thrombolysis.
The rural patients had a four minutes longer dispatch-to-arrival delay and 50 (34,
74) minutes longer transport time. The door-to-needle time was 8 (5, 14) minutes shorter
in rural patients than in urban patients.
Conclusions
Positive FAST findings and the use of priority dispatch code and priority transport
code were associated with shorter transport delays. There is room for improvement
in door-to-needle time and in stroke recognition by the dispatch centre and EMS providers.
For the rural population, helicopter transportation could reduce the long pre-hospital
time.
Abbreviations:
EMS (emergency medical services), ER (emergency room), ERCA (Emergency Response Centre Administration (EMS dispatch)), HEMS (helicopter emergency medical services), FAST (Face Arm Speech Test), GP (general practitioner), OUH (Oulu University Hospital), OTT (onset-to-treatment time)Keywords
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Article info
Publication history
Published online: February 21, 2019
Accepted:
January 29,
2019
Received in revised form:
January 23,
2019
Received:
October 5,
2018
Identification
Copyright
© 2019 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.
