Emergency Dispatcher Stroke Recognition: Associations with Downstream Care

Area of Science:

• Emergency Medicine
• Neurology
• Public Health

Background:

• Emergency dispatchers are the first point of contact for patients requiring emergency medical services (EMS).
• Early recognition of stroke by dispatchers is crucial for timely and effective patient care.
• Dispatcher stroke recognition influences subsequent EMS assessment and treatment.

Purpose of the Study:

• To quantify emergency dispatcher stroke recognition rates.
• To examine the relationship between dispatcher stroke recognition and EMS stroke recognition.
• To assess the impact of dispatcher recognition on EMS response times and treatment.

Main Methods:

• A cohort of 601 patients with suspected stroke or transient ischemic attack (TIA) was analyzed.
• Dispatcher sensitivity and positive predictive value (PPV) for stroke recognition were calculated.
• Multivariable logistic regression identified predictors of dispatcher recognition and its association with downstream care.

Main Results:

• Dispatchers suspected stroke in 70.7% of confirmed stroke/TIA cases (sensitivity) with a PPV of 45.3%.
• Dispatcher recognition was higher for ischemic strokes and lower for patients with visual deficits or vomiting.
• Dispatcher-recognized stroke cases showed increased on-scene stroke screening and EMS recognition.

Conclusions:

• Emergency dispatcher stroke recognition is linked to better on-scene stroke assessments and EMS recognition of ischemic stroke.
• Dispatcher recognition did not correlate with reduced transportation times, door-to-CT times, or t-PA delivery.
• Improving dispatcher stroke identification can enhance the stroke care pathway, but further interventions are needed to impact time-sensitive metrics.