Edel Burton, Rory Quinn, Emma Boseley, Conor Deasy, Heather Hutchinson, Mario Krammel, Adam Lloyd, Wayne Loudon, Terence Quinn, Siobhán Masterson, Neelesh C Mupparapu, Cathal O'Donnell, Jerry Overton, Harm Van de Pas, David Willis, Julia H Wolfe, Kieran Crosbie-Staunton, Vera J C McCarthy, Áine Merwick, Patricia M Kearney, Claire M Buckley, Prehospital Care of Stroke (PHoCoS) Consortium
Aligning time interval definitions across 7 ambulance services highlighted response and on-scene times as key contributors to prehospital delays during the pandemic. Future interventions should focus on these prehospital phases, particularly during times of increased pressure on the health care system.
BACKGROUND: International reports highlight the COVID-19 pandemic's wide-ranging impacts on time-sensitive conditions, including stroke/transient ischemic attack (TIA). Comparing ambulance time intervals globally offers insights into COVID-19's effects on different health care systems. This study aimed to compare ambulance time intervals for adults with suspected stroke/TIA across 7 services before and during the COVID-19 pandemic.
METHODS: We conducted a quasi-experimental before-and-after study examining the impact of COVID-19 on 5 ambulance time intervals and call volume for suspected stroke/TIA cases. International ambulance services using the Advanced Medical Priority Dispatch System provided data on all suspected stroke/TIA calls. Outcomes were compared between the pre-COVID-19 period (January 1, 2018, to the week before first identified case) and the COVID-19 period (first identified case to December 31, 2021) using descriptive, time-series, and regression analyses.
RESULTS: Four national (Republic of Ireland, New Zealand, Northern Ireland, and Scotland) and 3 regional (Queensland, Tilburg, and Vienna) services provided data on 273 362 suspected stroke/TIA cases. No consistent effect was observed on allocation performance, mobilization performance, or conveyance time. Mean response time increased significantly in all services (0.5-9.13 minutes) except New Zealand, where it decreased by 1.57 minutes. Mean on-scene time increased significantly across all services (1.05-3.78 minutes). Mean monthly call volume per 1000 emergency calls increased significantly in 6 services (16-40.5 cases), whereas the Netherlands showed no change.
CONCLUSIONS: Aligning time interval definitions across 7 ambulance services highlighted response and on-scene times as key contributors to prehospital delays during the pandemic. Future interventions should focus on these prehospital phases, particularly during times of increased pressure on the health care system.