Introduction

Stroke treatment must be given within the first few hours of symptom onset, so rapid Emergency Medical Services (EMS) response is essential for positive patient outcomes. Examining EMS response characteristics across temporal and geographical perspectives is critical for improving Alabama's stroke death rate from its current 49th place in the U.S.

Methods

We examined EMS delay characteristics for patients with suspected strokes from 2018-2019 across Alabama, with particular attention paid to rural and urban differences. We used EMS call data from the Alabama Department of Public Health and defined possible stroke cases as calls where a stroke scale completed by EMS was positive or indeterminate. We coded the time between EMS dispatch and destination arrival as EMS delay. This study incorporates global and local spatio-temporal weighted ordered logistic regression models to evaluate significant non-stationary correlations of factors with EMS delay by accounting for unobserved heterogeneity.

Results

We examined 17,088 possible stroke cases and found that 74% of these calls had total response times within 60 min. The longest EMS delay occurred in rural counties. EMS response characteristics, such as pre-arrival instructions and advanced vehicle navigation, were associated with shorter delays, while long travel distance and on-scene/transport times were associated with longer EMS delays. The impact of response characteristics on stroke-event-based EMS delay varied significantly across rural and urban counties and time (i.e., between 2018 and 2019).

Conclusion

The revealed spatio-temporal correlations are useful for EMS personnel in applying effective localized rural and urban EMS response improvement strategies.

中文翻译：

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阿拉巴马州中风事件的紧急医疗服务响应特征的时空综合分析

介绍

中风治疗必须在症状发作的最初几个小时内进行，因此快速的紧急医疗服务（EMS）响应对于阳性患者预后至关重要。从时间和地理角度检查EMS响应特征对于提高阿拉巴马州的卒中死亡率从目前的美国第49位起至关重要

方法

我们检查了阿拉巴马州2018-2019年间可疑中风患者的EMS延迟特征，并特别注意了城乡差异。我们使用了来自阿拉巴马州公共卫生部的EMS呼叫数据，并将可能的中风病例定义为EMS完成的中风量表为阳性或不确定的呼叫。我们将EMS派送与到达目的地之间的时间编码为EMS延迟。这项研究结合了全局和局部时空加权有序逻辑回归模型，以通过考虑未观察到的异质性来评估因素与EMS延迟的显着非平稳相关性。

结果

我们检查了17088个可能的中风病例，发现其中74％的呼叫在60分钟内具有总响应时间。EMS延误时间最长的是农村县。EMS响应特征（如到达前的指示和先进的车辆导航）与较短的延迟相关，而较长的行驶距离和现场/运输时间与较长的EMS延迟相关。响应特征对基于中风事件的EMS延误的影响在城乡县和时间（即2018年至2019年）之间差异很大。

结论

揭示的时空相关性对于EMS人员在应用有效的本地化农村和城市EMS响应改进策略方面很有用。