title: Emergency transport of stroke suspects in a rural state: opportunities for improvement.
abstract: BACKGROUND
  Time delay is the key obstacle for receiving successful stroke treatment. Alteplase therapy must start within 4.5 hours from stroke occurrence. Rapid transport to a primary stroke center (PSC) or acute stroke-ready hospital (ASRH) by the emergency medical system (EMS) paramedics is vital. We determined transport time and destination data for EMS-identified and -delivered stroke suspects in Arkansas during 2013. Our objective was to analyze transport time and the hospital qualification for stroke care across the state.
  
  
  METHODS
  The state's 75 counties were placed into 8 geographical regions (R1-R8). Transport time and hospital qualification were determined for all EMS-identified strokes. Each hospital's stroke care status was categorized as PSC, ASRH, a nonspecialty or unknown care facility (NSCF), out-of-state, or nonapplicable designation facilities.
  
  
  RESULTS
  There were 9588 EMS stroke ground transports with median within-region transport times of 29-40 minutes. Statewide, only 65% of EMS-transported stroke patients were transported to either PSC (12%) or ASRH (53%) facilities. One-third of the patients (30.6%) were delivered to NSCFs, where acute stroke therapy may rarely be performed. Regions with the highest suspected-stroke cases per capita also had the highest percentage of transports to NSCFs.
  
  
  CONCLUSIONS
  With only a few PSCs in Arkansas, EMS agencies should prioritize transporting stroke patients to ASRHs when PSCs are not regionally located.
authors.affiliation: Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205.
authors.forename: Aliza T
authors.initials: AT
authors.lastname: Brown
authors.affiliation: Department of Biostatistics, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205.
authors.forename: Feifei
authors.initials: F
authors.lastname: Wei
authors.affiliation: Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205.
authors.forename: William C
authors.initials: WC
authors.lastname: Culp
authors.affiliation: Arkansas Department of Health, Section of Emergency Medical Services, Little Rock, AR 72204.
authors.forename: Greg
authors.initials: G
authors.lastname: Brown
authors.affiliation: Arkansas Department of Health, Section of Emergency Medical Services, Little Rock, AR 72204.
authors.forename: Ryan
authors.initials: R
authors.lastname: Tyler
authors.affiliation: Arkansas Department of Health, Chronic Disease Prevention and Control Branch, Little Rock, AR 72204.
authors.forename: Appathurai
authors.initials: A
authors.lastname: Balamurugan
authors.affiliation: Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR 72205. Electronic address: nicolas.a.bianchi@emory.edu.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bianchi
mesh_terms: D004632:Emergency Medical Services / Q000592:standards*; D004634:Emergency Medical Technicians / Q000592:standards*; D006801:Humans; D058996:Quality Improvement; D012424:Rural Population; D020521:Stroke / Q000628:therapy*; D013997:Time Factors; D014481:United States