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Of 4413 EMS on-scene evaluations,the diagnosis of stroke or TIA was made by an EMT or paramedic for 96 patients(2%).Of the study population(n=86),a final hospital discharge diagnosis of stroke or TIA was made for 62 patients(72%).EMS dispatchers correctly identified 52%and paramedic 72%of these 86 patients as having sustained a stroke or TIA.Twenty-two of the 86 patients required paramedic-level interventions,which included three intubations.Of the 24 patients whose symptoms were misdiagnosed as stroke or TIA by the paramedics,16(19%)had acute conditions for which effective therapies are available.Prehospital personnel arrived at the scene to examine potential stroke patients in a mean of 3 minutes after the emergency 911 call was received by the dispatcher.Patients transported by basic life support units(EMTs)arrived earlier at the hospital than did those transported by advanced life support units(paramedics)(40+/-1 versus 45+/-1 minutes,P=.004).However,patients transported by advanced life support units were seen by a physician sooner after arrival at the emergency department(10+/1 2 versus 20+/-4 minutes,P=.02)and underwent computed tomography of the brain sooner(47+/-5 versus 69+/-10 minutes,P=. 04).Prehospital evaluation of potential stroke patients can be accomplished promptly after the EMS system is activated.Urgent evaluation and transport of potential stroke patients is justified because paramedic- level interventions are frequently required and because almost 20%of patients with potential stroke have acute medical conditions for which effective specific therapies are available. |
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cerebrovascular accident
cerebrovascular accident,acute management of
cerebrovascular accident,misdiagnosis
cerebrovascular accident,time of presentation
emergency medical technicians
misdiagnosis
neurologic disease,diagnoses of
paramedic
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