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. 2024 Mar 20;14(3):e078168.
doi: 10.1136/bmjopen-2023-078168.

Temporal trends of ambulance time intervals for suspected stroke/transient ischaemic attack (TIA) before and during the COVID-19 pandemic in Ireland: a quasi-experimental study

Edel Burton  1 , Rory Quinn  2 , Kieran Crosbie-Staunton  2 , Conor Deasy  3   4 , Siobhan Masterson  2   4   5 , Cathal O'Donnell  2 , Áine Merwick  6 , David Willis  2 , Patricia M Kearney  7 , Vera J C Mc Carthy  8 , Claire M Buckley  7
Affiliations

Temporal trends of ambulance time intervals for suspected stroke/transient ischaemic attack (TIA) before and during the COVID-19 pandemic in Ireland: a quasi-experimental study

Edel Burton et al. BMJ Open. .

Abstract

Objectives: Time is a fundamental component of acute stroke and transient ischaemic attack (TIA) care, thus minimising prehospital delays is a crucial part of the stroke chain of survival. COVID-19 restrictions were introduced in Ireland in response to the pandemic, which resulted in major societal changes. However, current research on the effects of the COVID-19 pandemic on prehospital care for stroke/TIA is limited to early COVID-19 waves. Thus, we aimed to investigate the effect of the COVID-19 pandemic on ambulance time intervals and suspected stroke/TIA call volume for adults with suspected stroke and TIA in Ireland, from 2018 to 2021.

Design: We conducted a secondary data analysis with a quasi-experimental design.

Setting: We used data from the National Ambulance Service in Ireland. We defined the COVID-19 period as '1 March 2020-31 December 2021' and the pre-COVID-19 period '1 January 2018-29 February 2020'.

Primary and secondary outcome measures: We compared five ambulance time intervals: 'allocation performance', 'mobilisation performance', 'response time', 'on scene time' and 'conveyance time' between the two periods using descriptive and regression analyses. We also compared call volume for suspected stroke/TIA between the pre-COVID-19 and COVID-19 periods using interrupted time series analysis.

Participants: We included all suspected stroke/TIA cases ≥18 years who called the National Ambulance Service from 2018 to 2021.

Results: 40 004 cases were included: 19 826 in the pre-COVID-19 period and 19 731 in the COVID-19 period. All ambulance time intervals increased during the pandemic period compared with pre-COVID-19 (p<0.001). Call volume increased during the COVID-19-period compared with the pre-COVID-19 period (p<0.001).

Conclusions: A 'shock' like a pandemic has a negative impact on the prehospital phase of care for time-sensitive conditions like stroke/TIA. System evaluation and public awareness campaigns are required to ensure maintenance of prehospital stroke pathways amidst future healthcare crises. Thus, this research is relevant to routine and extraordinary prehospital service planning.

Keywords: ACCIDENT & EMERGENCY MEDICINE; COVID-19; EPIDEMIOLOGY; Stroke.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Monthly time series graph of emergency call volume for suspected stroke/TIA from 2018 to 2021 displaying the COVID-19 period.
Figure 2
Figure 2
Actual (blue) versus predicted (red) call volume for suspected stroke/TIA for the COVID-19 period. TIA, transient ischaemic attack.
See this image and copyright information in PMC

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