Background/Purpose
Stroke is a leading cause of death and disability worldwide, with mortality rates increasing over the past decade. Timely treatment is crucial and hinges on an optimized “stroke chain of survival.” Despite established guidelines, 22–46% of EMS responses to stroke fail to meet recommended time benchmarks. Emergency dispatch systems play a pivotal role in early stroke identification, enabling rapid activation of specialized medical responses; yet dispatch is only ~40% accurate in detecting strokes. This review evaluates the strengths and limitations of current emergency dispatch systems for stroke and explores potential improvements through evolving technologies and protocols.
Methods
We conducted a structured literature review using PubMed, EMBASE, and the Cochrane Library. Search terms included “Emergency Medical Dispatch,” “Dispatch System,” and “Criteria-Based Dispatch.” We included English-language studies published between 1994 and 2024, focusing on clinical trials, observational studies, and systematic reviews evaluating dispatch protocols for stroke. Studies were screened independently by two reviewers using predefined inclusion (focus on stroke identification, dispatch process analysis) and exclusion (non-EMS settings, pediatric focus) criteria. Data was synthesized thematically.
Results
Among the 193 included studies, we found substantial variability in stroke detection criteria and procedures, resulting in inconsistent sensitivity, specificity, and diagnostic accuracy. Reported sensitivity ranged from 12–94%, and specificity from 20–99%. Accurate stroke identification at dispatch was associated with significant improvements in key process measures, including reduced time to stroke unit arrival, imaging, and thrombolysis. Conversely, delayed identification was linked to increased mortality risk. Technological innovations—such as telemedicine integration, Helicopter EMS (HEMS), and Mobile Stroke Units—enhanced prehospital stroke care by enabling real-time consultation, expedited transport, and early diagnosis. However, their success depends heavily on early, accurate detection by dispatchers.
Conclusions
While dispatch systems are vital to early stroke care, protocol variability contributes to missed or delayed diagnoses. Refining dispatch protocols for stroke could improve care and enhance the impact of emerging prehospital technologies. However, variability in study design and outcomes limits generalizability, underscoring the need for standardized research and protocol development. Future efforts should prioritize dispatch refinement, address barriers to early stroke recognition, and leverage data-driven strategies to improve accuracy.
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Previous poster presentation: University of Utah Medical Student Research Symposium
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Optimizing Dispatch Systems for Stroke Management: A Comprehensive Review by Matthew McKinnon & Holden Wagstaff, MD