Prehospital Phase of the Stroke Chain of Survival: A Prospective Observational Study

BACKGROUND: Few studies have discussed the emergency call and prehospital care as a continuous process to decrease the prehospital and in‐hospital delays for acute stroke. To identify features associated with early hospital arrival (<90 minutes) and treatment (<120 minutes), we analyzed the operation of current dispatch protocol and emergency medical services and compared stroke recognition by dispatchers and ambulance crews. METHODS AND RESULTS: This was a 2‐year prospective observational study. All stroke patients who were transported to the hospital by emergency medical services and received recanalization therapy were recruited for the study. For a sample of 308 patients, the stroke code was activated in 206 (67%) and high priority was used in 258 (84%) of the emergency calls. Emergency medical services transported 285 (93%) of the patients using the stroke code and 269 (87%) using high priority. In the univariate analysis, the most dominant predictors of early hospital arrival were transport using stroke code (P=0.001) and high priority (P=0.002) and onset‐to‐call (P<0.0001) and on‐scene times (P=0.052). In the regression analysis, the influences of high‐priority transport (P<0.01) and onset‐to‐call time (P<0.001) prevailed as significant in both dichotomies of early arrival and treatment. The on‐scene time was found to be surprisingly long (>23.5 minutes) for both early and late‐arriving patients. CONCLUSIONS: Fast emergency medical services activation and ambulance transport promoted early hospital arrival and treatment. Although patient‐dependent delays still dominate the prehospital process, it should be ensured that the minutes on the scene are well spent.