Introduction: Time delay is the key obstacle for receiving effective stroke treatment. The requirement for Alteplase therapy to begin within 3 hours of an ischemic stroke onset (4.5 hours off-label) causes treatment ineligibility among many patients, such that only 3-5% receives treatment. Rapid transport to a stroke-care qualified facility is vital. Time and destination data for emergency medical system (EMS) first-responders transporting identified strokes in 2013 were provided by the EMS section of the Arkansas Department of Health and analyzed for regional location, mode of transport, transport time and the destination’s qualification for stroke care.
Hypothesis: Rural regional EMS first-responders were transporting patients to non-qualified facilities even when there were nearby stroke-ready specialty centers available. We aimed at identifying potential areas for improvement within the system.
Methods: The state’s 75 counties were placed into eight geographical regions (R1-R8). For each region transport times for stroke suspects and the destination’s qualification for stroke care were determined for all EMS 911 ground-transport calls. Destinations were ranked as a Primary Stroke Center (PSC), Acute Stroke Ready Hospital (ASRH), Non-Specialty or unknown Care Facility (NSCF), or out-of-state facility.
Results: There were 9,688 verified EMS stroke ground transports with median within-region transport times ranging from 29.5 to 40 minutes. Statewide, only 65 percent of EMS-identified stroke 911-call patients were transported to either PSC (12%) or ASRH (53%) facilities. About one-third of the patients (30.4%) were delivered to NSCFs. In the regions (R6, R8) with the highest stroke suspects’ per-capita, up to 57% of transports were made to NSCFs.
Conclusions: As a rural state with few PSCs, Arkansas benefits from a widespread network of ASRHs, yet almost a third of stroke suspects were delivered to NSCFs, where acute stroke therapy rates and outcomes are unknown. Further work is needed to enhance the ASRH network development and utilization, including EMS destination protocols.