title: Prehospital Phase of the Stroke Chain of Survival: A Prospective Observational Study.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Emergency Medical Services, Helsinki University Hospital, Helsinki, Finland tuukka.puolakka@hus.fi.
authors.forename: Tuukka
authors.initials: T
authors.lastname: Puolakka
authors.affiliation: Department of Neurology and Clinical Neurosciences, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Strbian
authors.affiliation: Emergency Medical Services, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Heini
authors.initials: H
authors.lastname: Harve
authors.affiliation: Emergency Medical Services, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Markku
authors.initials: M
authors.lastname: Kuisma
authors.affiliation: Department of Neurology and Clinical Neurosciences, Helsinki University Hospital, Helsinki, Finland Research Programs Unit, Molecular Neurology, Biomedicum Helsinki, University of Helsinki, Finland.
authors.forename: Perttu J
authors.initials: PJ
authors.lastname: Lindsberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D000071820:Emergency Medical Dispatch; D004632:Emergency Medical Services; D005260:Female; D005387:Finland; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000628:therapy*; D015996:Survival Rate; D061665:Time-to-Treatment; D014187:Transportation of Patients
keywords: emergency medical services; stroke; time factors