Factors Associated with Delay of Emergency Medical Services Activation in Patients with Acute Stroke

The poor prognosis of acute stroke may be largely attributed to delays in treatment. Emergency medical services (EMS) usage is associated with a significant reduction in the delay in stroke treatment. The aims of this study were to identify factors associated with the delay in EMS activation for patients with acute stroke. This study was conducted at 26 Fire Safety Centers in five districts of Seoul, Korea. Patients with acute stroke transferred by EMS and admitted to a tertiary referral hospital from January 2014 to December 2018 were enrolled. In this cross-sectional study, the dependent variable was the time from stroke onset to EMS activation time. Patients were divided into two groups, onset-to-alarm time ≤ 30 min and onset-to-alarm time > 30 min, and previously collected patient data were analyzed. We performed logistical regression analyses of characteristics differing significantly between groups. Out of 480 patients, 197 (41%) had onset-to-alarm times > 30 min. Significant variables in the logistical analysis were alert mental state (adjusted odds ratio [aOR]: 2.77; 95% confidence interval [CI]: 1.31–6.13), pre-stroke mRS ≥ 2 (aOR: 2.46; 95% CI: 1.26–4.95), onset occurrence at private space (aOR: 2.31; 95% CI: 1.23–4.41), recognizing symptoms between 0 and 8 am (aOR: 2.30; 95% CI: 1.25–4.31), ischemic stroke (aOR: 1.88; 95% CI: 1.04–3.43), and witnessed by others (aOR: 0.32; 95% CI: 0.18–0.55). Delay in EMS activation for acute stroke cases is possibly related to difficult situations to recognize stroke symptoms, such as alert mental state, pre-stroke mRS ≥ 2, onset occurrence at private space, recognizing symptoms between 0 and 8 am, and unwitnessed by others.