Introduction: Acute stroke is a debilitating condition responsible for substantial morbidity and mortality and for which the efficacy of treatment is highly time dependent. As such, emergency medical services (EMS) are a key link in the stroke “chain of recovery.” However, studies of EMS stroke care are limited and suggest a high degree of variability in care. Methods: This analysis utilized linked data from state-level EMS and stroke registries in Michigan to perform an audit of EMS compliance with 6 performance measures derived from clinical guidelines, determine factors contributing to variability in compliance, and examine associations between EMS performance and downstream stroke care.Results: Among 5708 EMS-transported stroke cases identified between January 2018 and July 2019, compliance with performance measures varied widely. Patients with subarachnoid hemorrhage, those with very low or high stroke severity, and those who presented later tended to receive less compliant EMS care and there was substantial group-level variability between EMS agencies. In multivariable models, compliance with each of the EMS performance measures was associated with early CT acquisition in the Emergency Department. EMS stroke recognition and hospital prenotification were also associated with the odds of receiving timely acute ischemic stroke treatment with alteplase.Conclusions: EMS compliance with recommended practices for stroke was variable in Michigan and is influenced by both patient-level and EMS agency-level factors. EMS compliance with performance measures also predicts favorable stroke care following hospital arrival.
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