• Tuure Varjoranta, Lasse Raatiniemi, Kari Majamaa, Matti Martikainen, and Janne H Liisanantti.
• Research Unit of Surgery, Anesthesiology and Intensive Care, Oulu University, Oulu, Finland; Research Unit of Clinical Neurosciences, University of Oulu, Oulu, Finland.
• Australas Emerg Care. 2019 Jun 1; 22 (2): 76-80.

BackgroundThrombolysis improves stroke outcome, but efficacy of the treatment is limited by time. Therefore, recognition of stroke symptoms by dispatch centres and by emergency medical services (EMS) is crucial, as is minimization of pre-hospital delays. We investigated the pre-hospital delays in patients with stroke treated with thrombolysis and compared the delays between rural and urban patients.MethodsPatients that had received thrombolysis at Oulu University Hospital (OUH) between 1 January 2013 and 31 December 2015 were identified. Patients were divided into urban and rural based on the site of the EMS mission. Pre-hospital charts and medical records were reviewed. Onset-to-dispatch, dispatch-to-arrival of EMS, on-scene, transport and door-to-needle times were studied.ResultsThree hundred one stroke patients were treated with thrombolysis at OUH, and 232 of them were included in the study. Positive Face Arm Speech Test (FAST) findings, priority dispatch code and transport code were associated with shorter transport delays. The priority dispatch was not used in 12.5% of stroke patients treated with thrombolysis. The rural patients had a four minutes longer dispatch-to-arrival delay and 50 (34, 74) minutes longer transport time. The door-to-needle time was 8 (5, 14) minutes shorter in rural patients than in urban patients.ConclusionsPositive FAST findings and the use of priority dispatch code and priority transport code were associated with shorter transport delays. There is room for improvement in door-to-needle time and in stroke recognition by the dispatch centre and EMS providers. For the rural population, helicopter transportation could reduce the long pre-hospital time.Copyright © 2019 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

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