Ambulance crews failing to flag stroke arrivals

By Eleanor McDermid

Two studies from the Get With The Guidelines-Stroke initiative show that the emergency medical services (EMS) often fail to notify hospitals of an incoming stroke patient, despite the clear positive effect on acute stroke treatment.

Prenotification occurred for just two-thirds of the 371,988 patients in the studies, and the rate increased only slightly between 2003 and 2011, from 58.0% to 67.3%.

"Despite national guidelines recommending pre-notification by EMS for acute stroke patients, it's disappointing that there's been little improvement," said Gregg Fonarow (University of California, Los Angeles, USA), lead author of both studies, in a press statement.

"However, with these powerful new findings demonstrating substantial benefits with pre-notification, we have a tremendous opportunity to make positive changes in this component of stroke care."

After accounting for confounders, prenotification by the EMS resulted a significant 10.2% absolute increase in the proportion of patients who underwent imaging within 25 minutes of hospital arrival, a 3.3% increase in the proportion who underwent thrombolysis within 1 hour of arrival, and a 9.6% increase in the proportion who received thrombolysis within 3 hours of symptom onset (among those who arrived within 2 hours).

Prenotification by the EMS did not influence patients' risk for complications, show the findings in Circulation: Cardiovascular Quality and Outcomes.

The other study, published in the Journal of the American Heart Association, shows wide variation in EMS prenotification rates, with hospital-specific rates ranging from 0% to 100% and state-specific rates ranging from 19.7% in Washington, DC, to 93.4% in Montana.

"The large variations by state and hospital are really striking and should be a concern because the potential for ideal patient care isn't being met," said Fonarow.

The likelihood for EMS prenotification fell with increasing patient age and was reduced if patients were Black, had diabetes, previous vascular disease, or previous stroke.

"This tells us what we need to target EMS education," Fonarow said. "These patients are at higher risk for stroke and other ailments and may present challenges to EMS determining in the field whether their symptoms represent stroke. The goal is that EMS provides advanced notification for every potential stroke patient being transported."

The chances for EMS prenotification were also reduced if the receiving hospital had a very low annual thrombolysis rate (≤10/year) or was an academic center.

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