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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

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Variation in Prehospital Routing Patterns for Patients With Suspected Stroke.

Rebecca E Cash^1,2, Remle P Crowe³, Anjali Misra^1,2,4

¹Department of Emergency Medicine Massachusetts General Hospital Boston MA USA.

Journal of the American Heart Association

|December 3, 2025

Summary

One in ten patients with suspected stroke were transported to hospitals without stroke care capabilities. This highlights critical gaps in prehospital stroke care systems, especially in rural areas.

Keywords:

emergency medical services patient transport stroke

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Area of Science:

Emergency Medicine
Public Health
Health Services Research

Background:

Emergency Medical Services (EMS) transport destination practices for suspected stroke patients are not well understood.
Linking EMS patient care data with verified emergency department (ED) stroke capabilities offers a novel approach to assess these practices.

Purpose of the Study:

To describe EMS transport destination practices for patients with suspected stroke.
To identify factors influencing transport to EDs with verified stroke care capabilities.

Main Methods:

Cross-sectional evaluation of 314,642 EMS 9-1-1 encounters for suspected stroke (2019-2021).
Linked EMS data with National ED Inventory-USA survey data on verified ED stroke capabilities.
Used mixed effects logistic regression to analyze transport outcomes and between-agency variation.

Main Results:

10% of patients (32,142) were transported to facilities lacking verified stroke care capabilities.
Significant variation existed between EMS agencies (median OR > 2.0).
Rural location was associated with lower odds of transport to an ED with stroke care capabilities (OR 0.15).

Conclusions:

A significant proportion of suspected stroke patients receive prehospital care at facilities without verified stroke capabilities.
Inter-agency variation and rural disparities indicate critical gaps in prehospital stroke systems of care.
Improvements in EMS routing protocols are needed to ensure timely access to appropriate stroke care.