• Ganesh Asaithambi, Xin Tong, Kamakshi Lakshminarayan, Coleman KingSallyann MSMReceived November 15, 2020 from United Hospital Department of Neurosciences, Allina Health, St. Paul, Minnesota, USA (GA); Division of Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgi, Mary G George, and Erika C Odom.
• Received November 15, 2020 from United Hospital Department of Neurosciences, Allina Health, St. Paul, Minnesota, USA (GA); Division of Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA (XT, SMCK, MGG; ECO); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA (KL); Department of Neurology, University of Minnesota Medical School, Minneapolis, Minnesota, USA (KL). Revision received January 14, 2021; accepted for publication January 14, 2021.
• Prehosp Emerg Care. 2022 May 1; 26 (3): 326-332.

AbstractObjective: Emergency medical service (EMS) transportation after acute stroke is associated with shorter symptom-to-arrival times and more rapid medical attention when compared to patient transportation by private vehicle. Methods: We analyzed data from the Paul Coverdell National Acute Stroke Program from 2014 to 2019 among stroke (ischemic and hemorrhagic) and transient ischemic attack (TIA) patients to examine patterns in EMS utilization. Results: Of 500,829 stroke and TIA patients (mean age 70.9 years, 51.3% women) from 682 participating hospitals during the study period, 60% arrived by EMS. Patients aged 18-64 years vs. ≥65 years (AOR 0.67) were less likely to utilize EMS. Severe stroke patients (AOR 2.29, 95%CI, 2.15-2.44) and hemorrhagic stroke patients vs. ischemic stroke patients (AOR 1.47, 95% CI, 1.43-1.51) were more likely to utilize EMS. Medicare (AOR 1.35, 95% CI, 1.32-1.38) and Medicaid (AOR 1.41, 95% CI, 1.37-1.45) beneficiaries were more likely than privately insured patients to utilize EMS, but no difference was found between no insurance/self-pay patients and privately insured patients on EMS utilization. Overall, there was a decreasing trend in the utilization of EMS (59.6% to 59.3%, p = 0.037). The decreasing trend was identified among ischemic stroke (p < 0.0001) patients but not among TIA (p = 0.89) or hemorrhagic stroke (p = 0.44) patients. There was no observed trend in pre-notification among stroke patients' arrival by EMS across the study period (56.9% to 56.5%, p = 0.99). Conclusions: Strategies to help increase stroke awareness and utilization of EMS among those with symptoms of stroke should be considered in order to help improve stroke outcomes.

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