EMS response to stroke prompt in poor areas
NEW YORK, May 13 (Reuters) For people experiencing a stroke, living in a poor community does not appear to influence emergency medical service (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 theorized that socioeconomic status would affect emergency response time, because of factors such as the need for a police escort in high-crime areas, traffic congestion, and overcrowded and tall public housing buildings with nonworking elevators.
They examined the association between a community's socioeconomic status and the time between the 911 call and arrival in the emergency department in stroke patients. 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. Socioeconomic status among the 1.3 million residents varies widely, from extremely wealthy areas to areas with more than 70 per cent of the people living in poverty.
Patients who had a stroke in their home between January 1 and December 31, 1999 were included in the analysis. EMS on-scene time and emergency department arrival time were documented. The socioeconomic status of each community was based on data from the 2000 US Census Bureau Web site.
During the study period, 3,814 patients were hospitalised for a stroke or a transient ischemic attack (TIA), also referred to as a ''mini-stroke,'' which causes stroke-like symptoms that last no more than 24 hours. Other symptoms may include a sudden loss of function or sensation, along with dizziness, loss of vision, difficulty speaking or paralysis of the face, arm or leg.
Only 38.8 per cent of the subjects called 911. In this subgroup of patients, the average time between the call and arrival was 6.5 minutes, on-scene time was 14.1 minutes, and transport time was 13.1 minutes.
The poorest neighbourhoods experienced slightly longer times for EMS teams to reach the patient and to travel to the emergency department. But less time was spent on the scene in the poorer communities, so socioeconomic status had no clinically significant impact on the overall EMS response time from the 911 call to arrival at the emergency department.
Dr Kleindorfer's team writes: ''We would like to emphasise that 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 researchers suggest 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.'' Reuters SI VP1000