Access to hyperacute stroke services across Canadian provinces: a geospatial analysis
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Updated: Feb 28, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Prasanna Venkatesan Eswaradass1, Richard H Swartz1, Jamey Rosen1
1Affiliations: Calgary Stroke Program (Eswaradass, Hill), Department of Clinical Neurosciences, Cumming School of Medicine; Departments of Radiology (Hill), Community Health Sciences (Hill) and Medicine (Hill), Cumming School of Medicine, University of Calgary; Hotchkiss Brain Institute (Hill), Calgary, Alta.; Heart and Stroke Foundation (Lindsay), Ottawa, Ont.; Neurology Division (Swartz), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Geosyntec Consultants (Rosen), Guelph, Ont.
Background:
Canada's vast geography creates challenges for ensuring prompt transport to hospital of patients who have had a stroke. We sought to determine the proportion of people across various Canadian provinces for whom hyperacute stroke services are accessible within evidence-based time targets.
Methods:
We calculated, for the 8 provinces with available data, drive-time polygons on a map of Canada that delineated the area around stroke centres and emergency medical services (EMS) base centres to which one can drive in 3.5-6 hours. We calculated the proportional area of each forward sortation area (first 3 digits of the postal code) contained within a drive-time polygon. We applied this ratio to the 2011 Canadian census population of the forward sortation area to estimate the population that can reach a stroke centre in a designated time.
Results:
A total of 47.1%-96.4% of Canadians live within a 4.5-hour drive to a stroke centre via road EMS, and 53.3%-96.8% live within a 6-hour drive. Assuming a total travel time of 5 hours by EMS from base centre to patient and patient to hospital, 84.7%-99.8% of the population has access to a current or proposed endovascular thrombectomy site.
Interpretation:
Most Canadians live within 6 hours' road access to a stroke centre. Geospatial mapping could be used to inform decisions for additional sites and identify gaps in service accessibility. Coordinated systems of care and ambulance bypass agreements must continue to evolve to ensure maximal access to time-sensitive emergency stroke services.
