Background: Emergency medical Services (EMS) is a critical link in the chain of stroke survival. While studies in western countries have demonstrated improved care among EMS transported patients, little is known about EMS use in Asian-pacific countries with large traffic-burdened urban cities. Methods: Using Singapore National Stroke Registry data, we assessed nationwide EMS use in Singapore. Multivariate logistic regressions with the generalized estimating equations were used to examine the association between EMS use and timely stroke evaluation and treatment. Results: Of 3,780 patients with acute ischemic stroke admitted to all 5 public hospitals in Singapore between 2015 and 2016, 66% arrived via EMS. Patients more likely to use EMS were older, self-reported ethnicity as Indian (vs. Chinese), with more severe stroke, and with a history of ischemic heart disease, atrial fibrillation, or peripheral vascular disease. Patients transported by EMS were more likely to receive rapid evaluation (door-to-imaging time ≤25 minutes 34% vs. 11%, OR=3.30 [95% CI 1.68–6.48]) and were more likely to receive intravenous tissue plasminogen activator (tPA 22% vs. 4%, OR=6.73 [95% CI 4.66-9.72]). Among those who were treated with tPA, patients who arrived via EMS were more likely to receive timely treatment than self-transported patients (door-to-needle time ≤60 minutes 53% vs. 29%, OR=2.57 [95% CI 1.35–4.88]). Conclusions: EMS use is independently associated with timely stroke evaluation and treatment in Singapore. Seamless EMS-Hospital stroke pathways and targeted public campaigns to advocate for appropriate EMS use for acute stroke are recommended.
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