Communication Factors Associated With Stroke Identification During Emergency Calls – A Systematic Review

Introduction: The first opportunity for prompt identification of a stroke in the prehospital environment often occurs when people telephone for emergency medical services. A better understanding of how callers and dispatchers communicate during emergency calls may assist dispatcher identification of stroke. Objective: To conduct a systematic review of the literature to determine communication factors associated with the identification of stroke during emergency calls. Methods: Six databases were searched (CINAHL, Cochrane, Embase, Informit, MEDLINE and PsychInfo). To meet eligibility criteria, studies of emergency calls must have analysed communication in relation to whether the dispatcher identified the call as “stroke” or incorrectly classified the call as “other than stroke,” and included a stroke diagnosis by either paramedics at the scene or physicians in the hospital. Results: Database searching returned 696 unique citations, of which only four met the eligibility criteria. Studies included in this review considered only one type of communication factor associated with dispatcher identification of stroke, which was the caller’s use of keywords. The two key findings were: (1) caller mention of a “stroke” or typical stroke symptoms such as speech disturbance, facial weakness, and arm/limb weakness (i.e., FAST symptoms) was associated with increased dispatcher identification of stroke; and (2) caller description of the stroke as a fall-related event was associated with decreased detection of stroke. Conclusions: There is some evidence to suggest that particular keywords used by callers may help or hinder stroke identification by the dispatcher. It might be helpful for dispatchers to be aware of these common words and phrases. Future research could investigate how various factors in both the caller’s and dispatcher’s communication (such as accent, tone of voice, and use of grammatical structures) may affect identification of stroke by dispatchers. INTRODUCTION Acute stroke is a time-critical medical emergency. Definitive treatments, such as thrombolysis, are most effective when administered as early as possible after stroke.1 The first opportunity for prompt identification of a stroke in the prehospital environment often occurs when people telephone for emergency medical services.2 If stroke is identified during an emergency call, then ambulance resources can be dispatched at a high priority and time to treatment can be reduced.3 However, estimates of stroke identification by dispatchers indicate only one-third2, 4, 5 to one-half6-9 of all stroke cases are identified. Efforts to increase dispatcher identification of stroke have involved the introduction of various prehospital stroke screening tests10 and the use of scripted protocols to interview the caller.6 Another way to increase stroke identification during emergency calls may be to educate dispatchers about communication factors that are important for identifying stroke. 1. Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, Australia 2. St John Ambulance Western Australia, Belmont, WA, Australia 3. Royal Perth Hospital, Perth, WA, Austra-