A new Heart & Stroke study finds that most Canadians — no matter where they live — can reach an emergency stroke centre in time to receive life-saving treatments. Published today in CMAJ Open, the study found that despite Canada’s vast geography, more than 85% of Canadians live within six hours road access to a specialized stroke centre.
For many of these people, this means EMS (emergency medical services) can get them there in time to receive life-saving treatments.
Clot-busting drugs like alteplase (tPA) only work if you receive them within 4½ hours of the first stroke symptoms. Other breakthrough treatments, like endovascular therapy to remove a blood clot, can extend treatment times to at least six hours.
“The time-to-hospital arrival and subsequent treatment varies across provinces and, as you might expect, provinces with a lot of rural areas and residents more spread out have reduced accessibility,” says study co-author Dr. Patrice Lindsay, who is also the Heart & Stroke director of stroke. “A country as large and geographically diverse as Canada creates challenges for emergency medical services to get patients with stroke to hospital within the established treatment time window from symptom onset.”
Among the eight provinces included in the study – those with known EMS centre locations – 48% to 97% of the population by province live within a drive time of 4½ hours, allowing eligibility for the clot-busting drug alteplase (tPA), and 53% to 97% of the population live within six hours of a stroke enabled hospital by road EMS, resulting in more than 85% of the Canadian population who ideally have access to an endovascular site.
“This underscores why it is so important for people to know and react to the FAST signs of stroke,” says Dr. Lindsay. “The biggest barrier to surviving a stroke in Canada is people not recognizing and reacting to the signs. Stroke is a medical emergency and patients need to get to hospital as soon as possible to be in time to receive life-saving treatments.”
FAST is an easy and memorable way to remember the major signs of stroke. FAST stands for Face – is it drooping? Arms – can you raise them? Speech - is it slurred or jumbled? And Time – to call 9-1-1 right away.
Currently many stroke patients do not receive treatment because they present to the stroke hospital too late. Arrival by EMS (versus private transport) is associated with faster access to brain imaging and faster interpretation of these images. In Canada, 69% of admitted stroke patients are currently transported by EMS. The Canadian Stroke Best Practice Recommendations have established a target for EMS transport at 80%.
Dr. Lindsay notes that while the study results indicate most Canadians may be able to get to a centre in time, there are factors in addition to people recognizing and reacting to stroke warning signs which can impact access to timely stroke treatment. Canada’s geography, challenging landscapes and climate makes it almost impossible to get all patients to hospital in early enough time frames for treatment, even with systems improvements that lead to fast door to treatment times. People living in rural and remote locations in general have challenges accessing emergency medical services for any urgent conditions, and further, there are rules that EMS have to follow which limits their ability to cross certain boundaries. Similar patterns of access limitations to what we observed in this study have been seen in acute coronary syndrome access and in trauma care.
She recommends that coordinated systems of care and ambulance bypass agreements continue to evolve to ensure maximal access to time-sensitive emergency stroke services. “From here, we can work with provinces to improve accessibility, communication, and potentially identify more communities that would benefit most from extra emergency stroke centres and work to improve survival rates for all Canadians.”
The study authors created a special mapping system to plot stroke hospitals and paramedic stations, then calculated how many people in Canada live within 4.5 hours and six hours of a stroke hospital, using paramedics to get them there. They used locations of ambulance stations, along with every residential address reported in the last census and then factored in roads, speed limits and access to highways.
Geospatial mapping could also be broadly applied in healthcare to inform decisions for resource allocation to maximize population access, and to identify gaps in service accessibility across a range of health conditions and across geographic regions globally.
Prasanna Venkatesan Eswaradass (University of Calgary), Richard Swartz (University of Toronto), Jamey Rosen (Geosyntec Consultants), Michael D. Hill (University of Calgary), and Patrice Lindsay (Heart & Stoke)
- 62,000 strokes occur in Canada each year – that is one stroke every nine minutes.
- More than 400,000 Canadians are living with long-term disability from stroke.
- In the next two decades, the number of people living with long-term stroke disability will increase by 80 per cent to 726,000.
- Brain cells die at a rate of 1.9 million per minute after stroke.
- Each year, more than 13,000 Canadians die from stroke.
- Half of Canadians report having a close friend or family member who survived a stroke.
- Stoke is a powerful predictor of dementia: Having a stroke more than doubles someone’s risk of developing dementia.
About Heart & Stroke
Life. We don’t want you to miss it. That’s why Heart & Stroke leads the fight against heart disease and stroke. We must generate the next medical breakthroughs, so Canadians don’t miss out on more moments. Together, we are working to prevent disease, save lives and promote recovery through research, health promotion and public policy. (heartandstroke.ca)
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