Published: 2021-07-27

Stroke recognition efficiency by emergency medical dispatchers

Nantawan Tippayanate, Supalak Chaleepad, Nirun Intarut


Background: Delaying treatment for an acute stroke can typically lead to further severity and disastrous consequences. The majority of patients, however, did not arrive at the hospital in time to get thrombolysis. While the accuracy of stroke diagnosis by emergency medical dispatchers (EMDs) remains uncertain. The focus of this research was to assess the accuracy of the stroke detection (face-arm-speech-time tool) (FAST) utilized by EMDs for the management of acute stroke was as well as how it affected patients' time from door to CT and door-to-needle time.

Methods: From 1 January 2020 to 31 December 2020, this research was performed retrospectively. We included all patients over the age of 18 who had an acute stroke identified by incident dispatch code 18. Data was gathered using pre-hospital forms and hospital records. The CT scan findings were used to predict the overall diagnosis.

Results: Overall 244 patients, only 143 likely cases (62.4%) were identified by EMDs out of 181 final stroke diagnosis. Conversely, the specificity was 44.4 percent and the sensitivity was 63.5 percent. Only 19 patients (10.5%) obtained a CT scan within 60 minutes, per the data from acute stroke patients, whereas only 40 patients with acute ischemic stroke acquired r-TPA (22.1%).

Conclusions: It remains undecided if the failure to use FAST, the inability to recognize positive FAST indicators, or the failure to report FAST findings involves issues with EMDs assessments.



Stroke recognition accuracy, EMD, Door-to-needle time, Door to CT, Command control center

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Johnson W, Onuma O, Owolabi M, Sachdev S. Stroke: a global response is needed. Bull World Health Organ. 2016;94(9):634.

Kasmaei HD, Baratloo A, Nasiri Z, Soleymani M, Yazdani MO. Recombinant tissue plasminogen activator administration in patients with cerebrovascular accident; a case series. Arch Neuorsci. 2015;2(2):1-8.

Baratloo A, Rahimpour L, Abushouk AI, Safari S, Lee CW, Abdalvand A. Effects of telestroke on thrombolysis times and outcomes: a meta-analysis. Prehosp Emerg Care. 2018;22(4):472-84.

Nolte CH, Kuhnle Y, Ploner CJ, Muller- Nordhorn J, Mockle M. Improvement of door to imaging time in acute stroke patient by implementation of an all point alarm. J Stroke Cerebrovasc Dis. 2013;22(2):149-53.

Bray JE, Martin J, Cooper G, Barger B, Bernard S, Bladin C. Paramedic identification of stroke: community validation of the Melbourne ambulance stroke screen. Cerebrovasc Dis. 2005;20(1):28-33.

Kothari RU, Pancioli A, Liu T, Brott T, Broderick J. Cincinnati prehospital stroke scale: Reproducibility and validity. Ann Emerg Med. 1999;33(4):373-8.

Brandler ES, Sharma M, Sinert RH, Levine SR. Prehospital stroke scales in urban environments: A systematic review. Neurology. 2014;82(24):2241-9.

Williams TA, Blacker D, Arendts G, Patrick E, Brink D, Finn J. Accuracy of stroke identification by paramedic in a metropolitan pre hospital setting: a COHORT study. Austral J Med. 2017;14(2):1-9.

Lima FO, Silva GS, Furie KL, Frankel MR, Lev MH, Camargo ECS, et al. Field assessment stroke triage for emergency destination: a simple and accurate prehospital scale to detect large vessel occlusion strokes. Stroke. 2016;47(8):1997-2002.

Bray JE, Coughlan K, Barger B, Bladin C. Paramedic diagnosis of stroke: examining long-term use of the Melbourne ambulance stroke screen (MASS) in the field. Stroke. 2010;41(7):1363-6.

Ossa NPDL, Carrera D, Gorchs M, Querol M, Millán M, Gomis M, et al. Design and validation of a prehospital stroke scale to predict large arterial occlusion: the rapid arterial occlusion evaluation scale. Stroke. 2014;45(1):87-91.

National Stroke Foundation. National Stroke Audit-Acute Services Clinical Audit Report, Clinical Executive Summary 2013. Melbourne, Australia.

Williams TA, Finn J, Celenza A, Teng T, Jacobs IG. Paramedic identification of acute pulmonary edema in a metropolitan ambulance service. Prehosp Emerg Care. 2013;17(3):339-47.

Zhao H, Pesavento L, Coote S, Rodrigues E, Salvaris P, Smith K, et al. Ambulance clinical triage for acute stroke treatment: paramedic triage algorithm for large vessel occlusion. Stroke. 2018;49(4):945-51.

Caceres JA, Adil MM, Jadhav V, Chaudhry SA, Pawar S, Rodriguez GJ, et al. Diagnosis of stroke by emergency medical dispatchers and its impact on the prehospital care of patients. J Stroke Cerebrovasc Dis. 2013;22(8):610-4.