highest priority level in the ambulance, and a stroke diagnosis that was less likely to be recognized by prehospital clinicians. The median system delay, defined as time from emergency call by patient or bystander until start time of brain CT, was 30 minutes longer in those patients with lower socioeconomic status. Socioeconomic disparities in health care are well‐documented. This particular study points specifically to inequities concerning prehospital care. A delay of 30 minutes could prove significant for the availability and effectiveness of time‐sensitive treatment options [45].
Summary
Stroke represents a profound public health problem with potentially devastating effects. EMS plays important roles in addressing these. Engagement in public education is vital so that community members recognize stroke signs and symptoms promptly and activate the EMS system. Optimal interrogation of 9‐1‐1 callers leads to identification of potential stroke patients and appropriate prioritization of the EMS response. EMS clinicians should be well indoctrinated in the evaluation of potential stroke patients, including application of screening tools and suspicion for mimics. They must understand the regional stroke system in which they serve so they facilitate optimal definitive care by delivering patients to the most appropriate facility in the most expeditious manner. Stroke was once an illness that prompted a “wait and see” approach but is no more. It demands the attention of EMS leaders and researchers in close collaboration with health care system partners.
Acknowledgments
We acknowledge Todd Crocco, MD, Allison Tadros, MD, and Stephen M. Davis, MPA, MSW for their contributions as authors of this chapter in prior editions of this book.
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