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. 2023 Oct;18(9):1084-1091.
doi: 10.1177/17474930231177204. Epub 2023 May 30.

Results of an international survey on the status of prehospital care

Anthony G Rudd  1   2   3 , Jing Zhao  4   3 , Gary Ford  5   3 , Rita Melifonwu  6   7   3 , Siju V Abraham  8   3 , Marc Fisher  9   3 , Grethe Andersen  10   3 , David Waters  11   3 , Dou Li  12   3 , Renyu Liu  13   3
Affiliations

Results of an international survey on the status of prehospital care

Anthony G Rudd et al. Int J Stroke. 2023 Oct.

Abstract

Background: Prehospital care including recognition of stroke symptoms by the public and professionals combined with an efficient and effective emergency medical service (EMS) is essential to increase access to effective acute stroke care. We undertook a survey to document the status of stroke prehospital care globally.

Methods: A survey was distributed via email to the World Stroke Organization (WSO) members. Information was sought on the current status of stroke prehospital delay globally, including (1) ambulance availability and whether payment for use is required, (2) ambulance response times and the proportion of patients arriving at hospital by ambulance, (3) the proportion of patients arriving within 3 h and more than 24 h after symptom, (4) whether stroke care training of paramedics, call handlers, and primary care staff, (5) availability of specialist centers, and (6) the proportion of patients taken to specialist centers. Respondents were also asked to identify the top three changes in prehospital care that would benefit their population. Data were analyzed descriptively at both country and continent level.

Results: Responses were received from 116 individuals in 43 countries, with a response rate of 4.7%. Most respondents (90%) reported access to ambulances, but 40% of respondents reported payment was required by the patient. Where an ambulance service was available (105 respondents) 37% of respondents reported that less than 50% of patients used an ambulance and 12% less than 20% of patients used an ambulance. Large variations in ambulance response times were reported both within and between countries. Most of the participating high-income countries (HIC) offered a service used by patients, but this was rarely the case for the low- and middle-income countries (LMIC). Time to admission was often much longer in LMIC, and there was less access to stroke training for EMS and primary care staff.

Conclusions: Significant deficiencies in stroke prehospital care exist globally especially in LMIC. In all countries, there are opportunities to improve the quality of the service in ways that would likely result in improved outcomes after acute stroke.

Keywords: Stroke; emergency medical services; international; prehospital; quality of care; training.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: GF declares the following interests: Non-Executive Board Member of the National Institute for Health and Care Excellence, Chief Executive Officer of the Oxford Academic Health Science Network, which has multiple joint working agreements and medical education grants with industry partners, and personal fees for consultancy advice to CSL Behring. None of the other authors have any conflicts of interest to report.

Figures

Figure 1.
Figure 1.
World map showing participating countries and region, and the frequency of responses per country or region.
Figures 2.
Figures 2.
(a) The composition of the survey responders. (b) Proportions responding at local, regional, or national level.
Figure 3.
Figure 3.
Percentage of people who had relevant training.
See this image and copyright information in PMC

References

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