Rapid medical intervention is key to ensuring the best possible outcome for a patient experiencing stroke. The time that elapses from symptom onset to time of treatment is should be as short as possible. One way to decrease the time that elapses from symptom onset is the utilization of Emergency Medical Services (EMS). Outcomes of those who have arrived at hospital via EMS have been shown to be significantly better than those that delay care and self-report.  The benefits are not singularly due to rapidity of presentation to the hospital. Pre-hospital care can play an important role in stroke treatment, as emergency medical personnel can initiate life-saving and effective care in the field¹.

This metric is important and low percentages could be due to a myriad of factors. However, one important contributor could be population education. The first step to rapid diagnosis is the patient or patient's family recognizing the signs and symptoms of a stroke and calling 911. If Arkansans aren not aware of these signs and symptoms they are likely going to delay care and not act with urgency. One way the American Stroke Association has worked to improve education regarding stroke is through the FAST accronym². 

This particular metric does not have a determined benchmark nor is there available data for national average comparison. Nontheless, this metric is important to track.

Source: ¹Frankel, M & Hinchey, J & Schwamm, L.H. & Wall, Hilary & Rose, K.M. & George, Mary & McGruder, Henraya & Liban, A & Croft, J.B.. (2007). Prehospital and hospital delays after stroke onset - United States, 2005-2006. Morbidity and Mortality Weekly Report. 56. 474-478. 

Source:² Recognizing Stroke, accessed on April 2, 2019 from https://www.stroke.org/understand-stroke/recognizing-stroke/act-fast/

• Acute Stroke Care Task Force
• American College of Cardiology 
• Arkansas Department of Health Tobacco Cessation and Prevention Branch 
• Arkansas Department of Health Trauma Branch – Stroke and STEMI Section 
• Arkansas Department of Health Chronic Disease Branch 
• Heart Disease and Stroke Prevention Coalition 
• Mercy Telestroke System 
• UAMS Center for Distance Health - AR SAVES (Arkansas Stroke Assistance through Virtual Emergency Support)

Hospitals are strongly encouraged to work with EMS Agencies to perform QA/QI to improve community awareness and education targeting the importance of dialing “911” for transport to the ED for all symptoms of acute strokes, all positive stroke patients and all patients that were deemed to not be a stroke in the field that were later determined to have a stroke. Performing a detailed QA/QI review of all stroke patients transferred by EMS, provide opportunities for Arkansas hospitals’ stroke programs and EMS agencies to communicate, collaborate, and share educational initiatives to increase community education and awareness of the benefits of being transported to the ED by ambulance. Evidence suggests that active collaboration between hospitals and EMS is significantly associated with lower stroke related disabilities and mortality. Both higher and lower performing Arkansas Stroke Registry hospitals report that EMS is an essential component to quality improvement initiatives to provide timely care for all suspected acute stroke patients. Hospitals and EMS have included an in-depth amount of education on the importance not waiting until symptoms improve or for a family member to come home as part of its community outreach initiatives.

The ADH strongly encourages hospitals to work with EMS agenncies in order to improve community awareness and education in the importance of dialling "911" for all symptoms of stroke. This colaboration allows the Arkansas hospital's stroke programs ane EMS agenceies to communicate, collaborate, and share educational initiates. Both higher and lower performing Arkansas Stroke Registry hospitals report that EMS is an essential component to quality improvement initiatives to provide timely care for all suspected acute stroke patients. Hospitals and EMS have included an in-depth amount of education on the importance not waiting until symptoms improve or for a family member to come home as part of its community outreach initiatives. It is important for EMS and Hospitals to work together to decrease LKW times to arrival times. Hospitals and EMS uses a collaborative approach to provide stroke education and community outreach as methods to educate about EMS transfer of suspected acute stroke patients. The Arkansas Department of Health have developed a communication tool to support the suspected acute stroke patient handoff between EMS and hospitals. This evidence-based tool has improved communicating critical patient data and coordination of the suspected acute stroke handoff.