Calling emergency medical services for acute stroke: a study of 9-1-1 tapes

To obtain a better understanding of how stroke events are communicated to 9-1-1 telecommunicators, and how telecommunicators and emergency medical services (EMS) personnel respond to such calls.

The authors identified 104 patients with a hospital discharge diagnosis of stroke or transient ischemic attack who were transported to hospital by ambulance in two North Carolina counties during 1999 and 2000. Ambulance call reports were abstracted and linked to 9-1-1 call center audiotapes, which were transcribed and verified.

Of the 104 calls, 44 were made by medical personnel, 38 by a family member, eight by a bystander or neighbor, five undetermined, and three by other nonmedical personnel. In only six instances (6%) was the call placed by the patient. The most common symptoms reported were altered mental status (40%), trouble walking (32%), impaired speech (27%), and abnormal breathing (27%). Although the word "stroke" was often used (45%), 9-1-1 telecommunicators classified the calls as a stroke in only 31% of cases. However, in the majority of cases (79%), paramedics were dispatched at the highest priority. The median time from dispatch of EMS to patient arrival at the hospital was 41 minutes, approximately half of which was spent at the scene.

Although typical stroke symptoms are commonly described, calls are often not classified as "strokes" by telecommunicators. Nevertheless, because of the symptoms reported during the calls, the majority of cases are treated as high priority by telecommunicators.