Abstract Body: Introduction: Early recognition of acute stroke and activation of emergency medical services (EMS) is a critical first step in the stroke care continuum. Failure to call 9-1-1 and other delays in seeking care contribute to prolonged prehospital delays, often limiting access to time-sensitive treatment. To identify challenges in early initiation of EMS, we sought to understand stroke survivor and caregiver perspectives on seeking acute stroke care.
Methods: We conducted individual, semi-structured interviews with a convenience sample of adult stroke survivors and caregivers for patients with acute stroke that occurred in central North Carolina. In virtual interviews, participants were asked about stroke signs and symptoms experienced, their response, and care received from EMS and in the ED and hospital. Interviews were recorded, transcribed, and analyzed by two individual coders. Deductive coding and rapid thematic analysis focused on care-seeking behaviors and perspectives.
Results: Of 16 interviews conducted thus far, 10 were with stroke survivors and 6 were with accompanying caregivers (14 Non-Hispanic White; 13 used EMS). Stroke onset was promptly recognized when the patient/caregiver had prior experience with stroke, exposure to stroke education, or access to healthcare professionals among their personal circles. Early stroke recognition prompted over half of the caregivers or other bystanders (spouses, adult children, or neighbors) to call 9-1-1 right away. Symptoms perceived by the patient/caregiver as a non-stroke issue (e.g., migraine, seizure) or not severe enough led a third of the participants/caregivers to delay or fail to call 9-1-1. Some participants reported being aware of EMS costs; however, none reported delaying care-seeking due to these concerns. Other concerns with calling 9-1-1 included general apprehension of medical professionals and fear of being perceived as “the boy who cried wolf.”
Conclusion: Stroke survivors’ and caregivers’ perspectives highlighted accurate and early stroke recognition as a facilitator of prompt EMS initiation. Conversely, symptoms associated with other neurologic conditions or perceived as mild created delays in seeking care. Further recruitment is in progress until reaching at least 30 participants, focusing on racial and ethnic minority groups and underserved rural populations. Study findings will be used to develop effective solutions to challenges in seeking acute stroke care.