ABSTRACTS
Description of Stroke Care Delivered by EMS Clinicians in 2022Author: Alyssa Green, MS, NREMT-P | | Associate Authors: Morgan K. Anderson, MPH, CPH, Christopher B. Gage, MHS, NRP, Shea van den Bergh, MPH, Jonathan R. Powell, MPA, NRP, Ashish P. Panchal, MD, PhD
Introduction Emergency medical services (EMS) clinicians provide critical, time-sensitive care for patients presenting with suspected stroke. Although model evidence-based guidelines (EBGs) for these patients exist, there is limited research on national adherence to these best practices. Objective To describe nationwide EMS care delivery for patients with EMS-suspected stroke and evaluate compliance with key national guideline components. Methods In this retrospective analysis of the 2022 ImageTrend Collaborate dataset, we evaluated all 9-1-1 EMS activations with transport and primary Advanced Life Support (ALS) provider primary impression of stroke. For stable estimates of stroke care compliance, we excluded EMS agencies with less than six annual strokes. Key components of stroke care were identified from the National Model EMS Clinical Guidelines, including documented any stroke screen, 12-lead electrocardiogram, blood glucose, onset time/last known well (LKW/Onset), pre-alert hospital notification, and scene time < 15 minutes. Descriptive statistics were calculated on patient characteristics and EMS care practices. Provision of prehospital comprehensive stroke care was defined as providing all six components above. Results In 2022, 6,720,504 EMS responses with 43,555 events across 624 agencies met inclusion criteria. Patients were female (52.3%), median age 73 (IQR: 62–82) years, White (70.5%), located in an urban area (88.2%), incident location of Home/Residence (71.4%), and had stroke as dispatch reason (56.1%). The key components of stroke care had varying degrees of compliance: stroke assessment (83.9%), LKW/Onset (93.7%), blood glucose (85.1%), 12-lead (42.3%), pre-alert notification (58.7%), and on-scene time < 15 minutes (58.9%). At least four components were completed in 76.4% of patients, at least five components were completed in 43.0% of patients, and only 10.0% of patients had all six components completed. Conclusion In the presence of model EBGs designed to provide a standardized approach to patient care, prehospital stroke care delivery in the United States was widely variable. Specifically, 90% of patients did not receive the ideal nationally recommended prehospital treatment for stroke. This data may be limited by reporting bias in the medical record. Future efforts may focus on agency-level implementation of these criteria as a first step to improve patient-based outcomes.
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