Need to Prioritize Education of the Public Regarding Stroke Symptoms and Faster Activation of the 9-1-1 System: Findings from the Florida–Puerto Rico CReSD Stroke Registry

Hannah Gardener, Paul E. Pepe, Tatjana Rundek, Kefeng Wang, Chuanhui Dong, Maria Ciliberti, Carolina Gutierrez, Antonio Gandia, Peter Antevy, Wayne Hodges, Nils Mueller-Kronast, Charles Sand, Jose G. Romano, Ralph L. Sacco

Research output: Contribution to journalArticle

Abstract

Objective: Demographic differences (race/ethnicity/sex) in 9-1-1 emergency medical services (EMS) access and utilization have been reported for various time-dependent critical illnesses along with associated outcome disparities. However, data are lacking with respect to measuring the various components of time taken to reach definitive care facilities following the onset of acute stroke symptoms (i.e., stroke onset to 9-1-1 call, EMS response, time on-scene, transport interval) and particularly with respect to any differences across ethnicities and sex. Therefore, the specific aim of this study was to measure the various time intervals elapsing following the first symptom onset (FSO) from an acute stroke until stroke hospital arrival (SHA) and to delineate any race/ethnic/sex-related differences among any of those measurements. Methods: The Florida-Puerto Rico Stroke Registry (FLPRSR) is an on-going, voluntary stroke registry of hospitals participating in the Get with the Guidelines-Stroke initiative. The study population included patients treated at Florida hospitals participating in the FLPRSR between 2010 and 2014 who had called 9-1-1 and were managed and transported by EMS. In total, 10,481 patients (16% black, 8% Hispanic, 74% white) had complete data-sets that included birthdate/year, sex, ethnic background, date/hour/minute of FSO and date/hour/minute of EMS response, scene arrival, and SHA. Results: Median time from FSO to SHA was 339 minutes (interquartile range [IQR] of 284–442), 301 of which constituted the time elapsed from FSO to the 9-1-1 call (IQR =249–392) versus only 10 from 9-1-1 call to EMS arrival (IQR =7–14), 14 on-scene (IQR =11–18) and 12 for transport to SHA (IQR =8–19). The FSO to 9-1-1 call interval, being by far the longest interval, was longest among whites and blacks (302 minutes for both) versus 291 for Hispanics (p = 0.01). However, this 11-minute difference was not deemed clinically-significant. There were neither significant sex-related differences nor any racial/ethnic/sex differences in the relatively short EMS-related intervals. Conclusions: Following acute stroke onset, time elapsed for EMS response and transport is relatively short compared to the lengthy intervals elapsing between symptom onset and 9-1-1 system activation, regardless of demographics. Exploration of innovative strategies to improve public education regarding stroke symptoms and immediate 9-1-1 system activation are strongly recommended.

Original languageEnglish (US)
JournalPrehospital Emergency Care
DOIs
StateAccepted/In press - Jan 1 2018

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Registries
Stroke
Education
Emergency Medical Services
Sex Characteristics
Puerto Rico
Hispanic Americans
Demography
Critical Illness
Reaction Time
Guidelines

Keywords

  • 9-1-1 dispatcher
  • EMS
  • race/ethnicity
  • response intervals
  • stroke
  • stroke center

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency

Cite this

Need to Prioritize Education of the Public Regarding Stroke Symptoms and Faster Activation of the 9-1-1 System : Findings from the Florida–Puerto Rico CReSD Stroke Registry. / Gardener, Hannah; Pepe, Paul E.; Rundek, Tatjana; Wang, Kefeng; Dong, Chuanhui; Ciliberti, Maria; Gutierrez, Carolina; Gandia, Antonio; Antevy, Peter; Hodges, Wayne; Mueller-Kronast, Nils; Sand, Charles; Romano, Jose G.; Sacco, Ralph L.

In: Prehospital Emergency Care, 01.01.2018.

Research output: Contribution to journalArticle

Gardener, H, Pepe, PE, Rundek, T, Wang, K, Dong, C, Ciliberti, M, Gutierrez, C, Gandia, A, Antevy, P, Hodges, W, Mueller-Kronast, N, Sand, C, Romano, JG & Sacco, RL 2018, 'Need to Prioritize Education of the Public Regarding Stroke Symptoms and Faster Activation of the 9-1-1 System: Findings from the Florida–Puerto Rico CReSD Stroke Registry', Prehospital Emergency Care. https://doi.org/10.1080/10903127.2018.1525458
Gardener, Hannah ; Pepe, Paul E. ; Rundek, Tatjana ; Wang, Kefeng ; Dong, Chuanhui ; Ciliberti, Maria ; Gutierrez, Carolina ; Gandia, Antonio ; Antevy, Peter ; Hodges, Wayne ; Mueller-Kronast, Nils ; Sand, Charles ; Romano, Jose G. ; Sacco, Ralph L. / Need to Prioritize Education of the Public Regarding Stroke Symptoms and Faster Activation of the 9-1-1 System : Findings from the Florida–Puerto Rico CReSD Stroke Registry. In: Prehospital Emergency Care. 2018.
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title = "Need to Prioritize Education of the Public Regarding Stroke Symptoms and Faster Activation of the 9-1-1 System: Findings from the Florida–Puerto Rico CReSD Stroke Registry",
abstract = "Objective: Demographic differences (race/ethnicity/sex) in 9-1-1 emergency medical services (EMS) access and utilization have been reported for various time-dependent critical illnesses along with associated outcome disparities. However, data are lacking with respect to measuring the various components of time taken to reach definitive care facilities following the onset of acute stroke symptoms (i.e., stroke onset to 9-1-1 call, EMS response, time on-scene, transport interval) and particularly with respect to any differences across ethnicities and sex. Therefore, the specific aim of this study was to measure the various time intervals elapsing following the first symptom onset (FSO) from an acute stroke until stroke hospital arrival (SHA) and to delineate any race/ethnic/sex-related differences among any of those measurements. Methods: The Florida-Puerto Rico Stroke Registry (FLPRSR) is an on-going, voluntary stroke registry of hospitals participating in the Get with the Guidelines-Stroke initiative. The study population included patients treated at Florida hospitals participating in the FLPRSR between 2010 and 2014 who had called 9-1-1 and were managed and transported by EMS. In total, 10,481 patients (16{\%} black, 8{\%} Hispanic, 74{\%} white) had complete data-sets that included birthdate/year, sex, ethnic background, date/hour/minute of FSO and date/hour/minute of EMS response, scene arrival, and SHA. Results: Median time from FSO to SHA was 339 minutes (interquartile range [IQR] of 284–442), 301 of which constituted the time elapsed from FSO to the 9-1-1 call (IQR =249–392) versus only 10 from 9-1-1 call to EMS arrival (IQR =7–14), 14 on-scene (IQR =11–18) and 12 for transport to SHA (IQR =8–19). The FSO to 9-1-1 call interval, being by far the longest interval, was longest among whites and blacks (302 minutes for both) versus 291 for Hispanics (p = 0.01). However, this 11-minute difference was not deemed clinically-significant. There were neither significant sex-related differences nor any racial/ethnic/sex differences in the relatively short EMS-related intervals. Conclusions: Following acute stroke onset, time elapsed for EMS response and transport is relatively short compared to the lengthy intervals elapsing between symptom onset and 9-1-1 system activation, regardless of demographics. Exploration of innovative strategies to improve public education regarding stroke symptoms and immediate 9-1-1 system activation are strongly recommended.",
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author = "Hannah Gardener and Pepe, {Paul E.} and Tatjana Rundek and Kefeng Wang and Chuanhui Dong and Maria Ciliberti and Carolina Gutierrez and Antonio Gandia and Peter Antevy and Wayne Hodges and Nils Mueller-Kronast and Charles Sand and Romano, {Jose G.} and Sacco, {Ralph L.}",
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T1 - Need to Prioritize Education of the Public Regarding Stroke Symptoms and Faster Activation of the 9-1-1 System

T2 - Findings from the Florida–Puerto Rico CReSD Stroke Registry

AU - Gardener, Hannah

AU - Pepe, Paul E.

AU - Rundek, Tatjana

AU - Wang, Kefeng

AU - Dong, Chuanhui

AU - Ciliberti, Maria

AU - Gutierrez, Carolina

AU - Gandia, Antonio

AU - Antevy, Peter

AU - Hodges, Wayne

AU - Mueller-Kronast, Nils

AU - Sand, Charles

AU - Romano, Jose G.

AU - Sacco, Ralph L.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective: Demographic differences (race/ethnicity/sex) in 9-1-1 emergency medical services (EMS) access and utilization have been reported for various time-dependent critical illnesses along with associated outcome disparities. However, data are lacking with respect to measuring the various components of time taken to reach definitive care facilities following the onset of acute stroke symptoms (i.e., stroke onset to 9-1-1 call, EMS response, time on-scene, transport interval) and particularly with respect to any differences across ethnicities and sex. Therefore, the specific aim of this study was to measure the various time intervals elapsing following the first symptom onset (FSO) from an acute stroke until stroke hospital arrival (SHA) and to delineate any race/ethnic/sex-related differences among any of those measurements. Methods: The Florida-Puerto Rico Stroke Registry (FLPRSR) is an on-going, voluntary stroke registry of hospitals participating in the Get with the Guidelines-Stroke initiative. The study population included patients treated at Florida hospitals participating in the FLPRSR between 2010 and 2014 who had called 9-1-1 and were managed and transported by EMS. In total, 10,481 patients (16% black, 8% Hispanic, 74% white) had complete data-sets that included birthdate/year, sex, ethnic background, date/hour/minute of FSO and date/hour/minute of EMS response, scene arrival, and SHA. Results: Median time from FSO to SHA was 339 minutes (interquartile range [IQR] of 284–442), 301 of which constituted the time elapsed from FSO to the 9-1-1 call (IQR =249–392) versus only 10 from 9-1-1 call to EMS arrival (IQR =7–14), 14 on-scene (IQR =11–18) and 12 for transport to SHA (IQR =8–19). The FSO to 9-1-1 call interval, being by far the longest interval, was longest among whites and blacks (302 minutes for both) versus 291 for Hispanics (p = 0.01). However, this 11-minute difference was not deemed clinically-significant. There were neither significant sex-related differences nor any racial/ethnic/sex differences in the relatively short EMS-related intervals. Conclusions: Following acute stroke onset, time elapsed for EMS response and transport is relatively short compared to the lengthy intervals elapsing between symptom onset and 9-1-1 system activation, regardless of demographics. Exploration of innovative strategies to improve public education regarding stroke symptoms and immediate 9-1-1 system activation are strongly recommended.

AB - Objective: Demographic differences (race/ethnicity/sex) in 9-1-1 emergency medical services (EMS) access and utilization have been reported for various time-dependent critical illnesses along with associated outcome disparities. However, data are lacking with respect to measuring the various components of time taken to reach definitive care facilities following the onset of acute stroke symptoms (i.e., stroke onset to 9-1-1 call, EMS response, time on-scene, transport interval) and particularly with respect to any differences across ethnicities and sex. Therefore, the specific aim of this study was to measure the various time intervals elapsing following the first symptom onset (FSO) from an acute stroke until stroke hospital arrival (SHA) and to delineate any race/ethnic/sex-related differences among any of those measurements. Methods: The Florida-Puerto Rico Stroke Registry (FLPRSR) is an on-going, voluntary stroke registry of hospitals participating in the Get with the Guidelines-Stroke initiative. The study population included patients treated at Florida hospitals participating in the FLPRSR between 2010 and 2014 who had called 9-1-1 and were managed and transported by EMS. In total, 10,481 patients (16% black, 8% Hispanic, 74% white) had complete data-sets that included birthdate/year, sex, ethnic background, date/hour/minute of FSO and date/hour/minute of EMS response, scene arrival, and SHA. Results: Median time from FSO to SHA was 339 minutes (interquartile range [IQR] of 284–442), 301 of which constituted the time elapsed from FSO to the 9-1-1 call (IQR =249–392) versus only 10 from 9-1-1 call to EMS arrival (IQR =7–14), 14 on-scene (IQR =11–18) and 12 for transport to SHA (IQR =8–19). The FSO to 9-1-1 call interval, being by far the longest interval, was longest among whites and blacks (302 minutes for both) versus 291 for Hispanics (p = 0.01). However, this 11-minute difference was not deemed clinically-significant. There were neither significant sex-related differences nor any racial/ethnic/sex differences in the relatively short EMS-related intervals. Conclusions: Following acute stroke onset, time elapsed for EMS response and transport is relatively short compared to the lengthy intervals elapsing between symptom onset and 9-1-1 system activation, regardless of demographics. Exploration of innovative strategies to improve public education regarding stroke symptoms and immediate 9-1-1 system activation are strongly recommended.

KW - 9-1-1 dispatcher

KW - EMS

KW - race/ethnicity

KW - response intervals

KW - stroke

KW - stroke center

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