Activation of emergency medical services for acute stroke in a nonurban population - The TLL Temple Foundation Stroke Project

Background and Purpose-Activating emergency medical services (EMS) is the m ost important factor in reducing delay times to hospital arrival for stroke patients. Determining who calls 911 for stroke would allow more efficient targeting of public health initiatives. Methods-The T.L.L. Temple Foundation Stroke Project is an acute stroke surv eillance and intervention project in nonurban East Texas. Prospective case ascertainment allowed chart abstraction and structured interviews for all h ospitalized stroke patients to determine if EMS was activated, and if so, b y whom. Results-Of 429 validated strokes, 38.0% activated EMS by calling 911. Logis tic regression analysis comparing those who called 911 with those who did n ot activate EMS found that individuals who were employed were 81% less like ly to have EMS activated (OR 0.19, 95% CI 0.04 to 0.63). Of the 163 cases i n which 911 was called, the person activating EMS was: self (patient), 4.3% ; family member of significant other, 60.1%; paid caregiver, 18.4%; and cow orker or other, 12.9%. Significant associations between the variables age g roup (P=0.02), insurance status (P=0.007), and living alone (P=0.05) with w ho called 911 was found on chi(2) analysis. Conclusions-Educational efforts directed at patients themselves at risk for stroke may be of low yield. To increase the use of time dependent acute st roke therapy, interventions may wish to concentrate on family, caregivers, and coworkers of high-risk patients. Large employers may be good targets to increase utilization of EMS services for acute stroke.