title: Emergency medical service in the stroke chain of survival.
abstract: BACKGROUND
  The Emergency Medical Services (EMS) play a primordial role in the early management of adults with acute ischaemic stroke (AIS). The aim of this study was to evaluate the role and effectiveness of the EMS in the stroke chain of survival in Marseille.
  
  
  METHODS
  A retrospective observational study was conducted in patients treated for AIS or transient ischaemic attack in three emergency departments and at the Marseille stroke centre over a period of 12 months.
  
  
  RESULTS
  In 2009, of 1034 patients ultimately presenting a diagnosis of AIS or transient ischaemic attack, 74% benefited from EMS activation. Dispatchers correctly diagnosed 57% of stroke patients. The symptoms most frequently reported included limb weakness, speech problems and facial paresis. Elements resulting in misdiagnosis by dispatchers were general discomfort, chest pain, dyspnoea, fall or vertigo. Stroke patients not diagnosed by emergency medical dispatchers but calling within 3 h of symptom onset accounted for 20% of cases.
  
  
  CONCLUSIONS
  Our study demonstrates that public intervention programmes must stress the urgency of recognizing stroke symptoms and the importance of calling EMS through free telephone numbers. Further efforts are necessary to disseminate guidelines for healthcare providers concerning stroke recognition and the new therapeutic possibilities in order to increase the likelihood of acute stroke patients presenting to a stroke team early enough to be eligible for acute treatment. In addition, EMS dispatchers should receive further training about atypical stroke symptoms, and 'Face Arm Speech Test' tests must be included in the routine questionnaires used in emergency medical calls concerning elderly persons.
authors.affiliation: Department of Emergency Medicine and Intensive Care, Timone University, Marseille, France. chenaitiahichem@gmail.com
authors.forename: Hichem
authors.initials: H
authors.lastname: Chenaitia
authors.forename: Oriane
authors.initials: O
authors.lastname: Lefevre
authors.forename: Vanessa
authors.initials: V
authors.lastname: Ho
authors.forename: Christian
authors.initials: C
authors.lastname: Squarcioni
authors.forename: Vincent
authors.initials: V
authors.lastname: Pradel
authors.forename: Marc
authors.initials: M
authors.lastname: Fournier
authors.forename: Richard
authors.initials: R
authors.lastname: Toesca
authors.forename: Pierre
authors.initials: P
authors.lastname: Michelet
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Auffray
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis* / Q000401:mortality; D004632:Emergency Medical Services; D005260:Female; D005602:France; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000175:diagnosis* / Q000401:mortality