Analysis Of The Status Of Emergency Medical Service Application In The Acute Stroke Treatment Of Hebei Province

Objective: To investigate the status of emergency medical service application of Hebei Province and preliminary analyses its value in the treatment of acute stroke patients.Methods: We collected information about patients with acute ischemic stroke admission to the emergency department between January 2016 and December 2016 in 49 hospitals from Hebei Province.Patients were divided into EMS group and non-EMS group in accordance with the pattern of arriving hospital.The general data,onset to emergency department arrival time,time from admission to treatment,thrombolytic rate,hospital stay and prognosis were compared between the two groups.The date were analyzed by SPSS 19.0.Results: A total of 4147 acute stroke patients were collected.Of these,2562 patients were males and 1585 patients were females(males: females,1.62:1).The mean age of patients was(64.28±12.24)years old.Hemorrhagic stroke in 589 cases(14.2%)and ischemic stroke occurred in 3558 cases(85.8%).There was a total of 750 cases(18.1%)admitted to the hospital by EMS.The proportion of EMS utilization for hemorrhagic stroke was 33.4% higher than that of ischemic stroke 15.5%(P<0.001).The median time from onset to emergency department arrival in EMS group was 1.75 hours lower than that in non-EMS group 4.57 hours(P< 0.001).The median time of onset-to-door time within 1 hour in EMS group was 0.67 hour,which was higher than that of non-EMS group(0.67 h vs 0.53 h,P<0.001).No significant difference was found from 1-<2 hours and 2-<3 hours.The median time of onset-to-door time?3 hours in EMS group was 5.0 hours,which was lower than that of non-EMS group 9.47 hours(P<0.001).In EMS group,the proportion of patients with onset-to-door time<3 hours was 66.13%,which was higher than that of non-EMS group(66.13% vs 57.44%,P <0.001).Compared with non-EMS group,the time length of door to treatment was much shorter(87 min vs 101 min,P<0.001).Hospital stay in EMS group was 10.97±6.99 days,which was lower than that of non EMS group(10.97±6.99 d vs 12.66±9.75 d,P<0.001).In EMS group,15.9% patients received thrombolytic therapy whereas only 11.0% patients in non EMS group(P=0.001).In EMS group,88.8% patients achieved more favorable outcomes at discharge than 85.5% in non EMS group(P=0.02).Conclusion: EMS is considered being effective in shortening onset-to-door time,reducing door to treatment time,improving thrombolytic rate,reducing hospitalization days,enhancing the prognosis of patients.