Comparative Analysis of Prehospital Response Times in Ischemic Stroke Cases: A Study from Verona Province

Ischemic stroke represents one of the most significant causes of morbidity and mortality worldwide, with early recognition and timely prehospital intervention playing a crucial role in improving overall patient outcomes. In Italy, stroke continues to be the second leading cause of death, with an annual incidence estimated to range between 95 and 290 cases per 100,000 inhabitants. Given the substantial burden of this condition, optimizing prehospital management is of paramount importance. Methods: A retrospective observational study was conducted analyzing 1,051 emergency cards from the calendar year 2023 with a final diagnosis of ischemic stroke. After applying exclusion criteria, 944 cases were evaluated, managed by different emergency medical services: nurse-staffed ambulances (MSI, n=762), helicopter emergency medical services (HEMS, n=20), physician-staffed ambulances (MSAn=33), and medical -car services (n=129). Primary outcomes measured were time on target for each service type and the impact of advanced airway management on these times. Comparative analysis was performed between different service types and between intubated vs. non-intubated patients. Results: Both nurse-staffed (average: 22 min) and physician-staffed ambulances (average: 18 min) demonstrated significantly shorter time on target compared to medical car (average: 41 min for intubated patients, 29 min for non-intubated patients). HEMS maintained comparable times to nurse-staffed ambulances (average: 21 min for non-intubated patients, 25 min for intubated patients). The overall intubation rate for ischemic stroke patients was 1.23% (13/1,051), with similar rates between HEMS (10%) and road-based physician services (9%). Orotracheal intubation increased time on target by an average of 4 minutes for HEMS teams and 12 minutes for road-based physician teams. Conclusions: In conclusion, when responding to patients with a suspected ischemic stroke who are not expected to require advanced airway management, the most efficient and time-sensitive emergency medical response options are ambulances that are staffed either by nurses (MSI) or by physicians (MSA). These types of vehicles enable prompt on-scene assessment, stabilization, and transportation to an appropriate medical facility without unnecessary delays. However, in situations where a patient is experiencing a suspected stroke and is located at a considerable geographical distance from the nearest hospital equipped with a specialized stroke unit, the deployment of a Helicopter Emergency Medical Service (HEMS) should be prioritized. Due to its ability to cover long distances in a significantly shorter time frame, HEMS represents the most effective pre-hospital transport solution for these patients, ensuring that they reach definitive stroke care as quickly as possible. On the other hand, the use of self-medication services or the dispatch of a medical car (automedica) for this patient population has been associated with an average delay of approximately 10 minutes in initiating critical pre-hospital care, without offering any significant additional treatment advantages compared to nurse-staffed ambulances. These findings offer essential insights and practical guidance for emergency medical dispatchers, enabling them to make more strategic and informed decisions regarding the optimal allocation of emergency resources. By improving pre-hospital response efficiency, these optimized dispatch strategies could contribute to reducing treatment delays, ultimately enhancing the overall quality of time-sensitive stroke care and improving patient outcomes.