title: The impact of ambulance practice on acute stroke care.
abstract: OBJECTIVE
  Few patients with acute stroke are treated with alteplase, often due to significant prehospital delays after symptom onset. The aims of this study were to: (1) identify factors associated with rapid first medical assessment in the emergency department after a call for ambulance assistance, and (2) determine the impact of ambulance practice on times from the ambulance call to first medical assessment in the emergency department.
  
  
  METHODS
  During a 6-month period in 2004, all ambulance-transported patients with stroke or transient ischemic attack arriving from a geographically defined region in Melbourne, Australia (population 383,000) to one of 3 hospital emergency departments were assessed prospectively. Ambulance records including the tape recording of the call for ambulance assistance and hospital medical records, were analyzed.
  
  
  RESULTS
  One hundred ninety-eight patients were included in the study. One hundred eighty-seven ambulance patient care records were complete and available for analysis. Factors associated with first medical assessment in the emergency department <60 minutes from the ambulance call and <10 minutes from hospital arrival were: Glasgow Coma Scale <13 (P<0.001 and P=0.021) and hospital prenotification (P=0.04 and P<0.001). Paramedic stroke recognition and hospital prenotification were associated with shorter times from the ambulance call to first medical assessment (P=0.001 and P<0.001).
  
  
  CONCLUSIONS
  Paramedic stroke recognition and hospital prenotification are associated with shorter prehospital times from the ambulance call to hospital arrival and in-hospital times from hospital arrival to first medical assessment. This highlights the importance of including ambulance practice in comprehensive care pathways that span the whole process of stroke care.
authors: National Stroke Research Institute, Level 1 Neurosciences Building, Austin Health, 300 Waterdale Road, Heidelberg Heights Victoria 3181, Australia. imosley@nsri.org.au
authors: Ian
authors: I
authors: Mosley
authors: Marcus
authors: M
authors: Nicol
authors: Geoffrey
authors: G
authors: Donnan
authors: Ian
authors: I
authors: Patrick
authors: Fergus
authors: F
authors: Kerr
authors: Helen
authors: H
authors: Dewey
mesh_terms: D000208:Acute Disease; D000368:Aged; D000488:Allied Health Personnel; D000552:Ambulances; D001315:Australia; D003191:Comprehensive Health Care; D004631:Emergency Medical Service Communication Systems; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000628:therapy; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011446:Prospective Studies; D020521:Stroke / Q000175:diagnosis / Q000628:therapy*; D013997:Time Factors