Evaluation of pre-hospital transport time of stroke patients to thrombolytic treatment.
BACKGROUND
Effective treatment of stroke is time dependent. Pre-hospital management is an important link in reducing the time from occurrence of stroke symptoms to effective treatment. The aim of this study was to evaluate time used by emergency medical services (EMS) for stroke patients during a five-year period in order to identify potential delays and evaluate the reorganization of EMS in Copenhagen in 2009.


METHODS
We performed a retrospective analysis of ambulance records from stroke patients suitable for thrombolysis from 1 January 2006 to 7 July 2011. We noted response time from dispatch of the ambulance to arrival at the scene, on-scene time and transport time to the hospital-in total, alarm-to-door time. In addition, we noted baseline characteristics.


RESULTS
We reviewed 481 records (58% male, median age 66 years). The median (IQR) alarm-to-door time in minutes was 41 (33-52), of which 18 (12-24) minutes were spent on scene. Response time was reduced from the period before to the period after reorganization (7 vs. 5 minutes, p <0.001). In a linear multiple regression model, higher patient age and longer distance to the hospital correlated with significantly longer transportation time (p <0.001).


CONCLUSIONS
This study shows an unchanged alarm-to-door time of 41 minutes over a five-year period. Response time, but not total alarm-to-door time, was reduced during the five years. On-scene time constituted nearly half of the total alarm-to-door time and is thus a point of focus for improvement.
Glostrup Stroke Centre, Department of Neurology, Glostrup Hospital, Copenhagen University Hospital, Nordre ringvej 57, Glostrup, 2600, Denmark. sofie.a.s@gmail.com.
Sofie Amalie
SA
Simonsen
Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen East, 2100, Denmark. andresen@gmail.com.
Morten
M
Andresen
Glostrup Stroke Centre, Department of Neurology, Glostrup Hospital, Copenhagen University Hospital, Nordre ringvej 57, Glostrup, 2600, Denmark. lene.michelsen@dadlnet.dk.
Lene
L
Michelsen
Emergency Medical Services, Copenhagen, Capital Region of Denmark, Telegrafvej 5, Ballerup, 2750, Denmark. soeren.viereck@regionh.dk.
Søren
S
Viereck
Emergency Medical Services, Copenhagen, Capital Region of Denmark, Telegrafvej 5, Ballerup, 2750, Denmark. lippert@regionh.dk.
Freddy K
FK
Lippert
Glostrup Stroke Centre, Department of Neurology, Glostrup Hospital, Copenhagen University Hospital, Nordre ringvej 57, Glostrup, 2600, Denmark. helle.iversen.01@regionh.dk.
Helle Klingenberg
HK
Iversen
D000328:Adult; D000368:Aged; D000552:Ambulances / Q000706:statistics & numerical data*; D002544:Cerebral Infarction / Q000628:therapy*; D004632:Emergency Medical Services / Q000458:organization & administration; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019984:Quality Indicators, Health Care / Q000458:organization & administration*; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D014187:Transportation of Patients / Q000458:organization & administration*
D005343:Fibrinolytic Agents