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A ripple effect in prehospital stroke patient care

ABSTRACT We examine a ripple effect in prehospital stroke care processes. Stroke patient care in prehospital stages is provided by emergency medical services (EMS). We divide EMS processes into three segments: dispatcher, field provider service without a patient (i.e., en route to the patient scene), and field provider service with a patient (i.e., transporting the patient to a hospital). We use both empirical and analytical models in this study. The results of the empirical analysis suggest that the dispatcher's stroke identification can influence the time performance of the dispatch center itself and of the subsequent downstream processes of the prehospital stroke care, indicating a potential ripple effect in the care system. Our analytical models demonstrate the impact of misidentification (i.e., a disruptive event at the dispatcher stage) and the unavailability of an Advanced Life Support (ALS) ambulance (i.e., a disruptive event at the field provider stage) on the severity of the stroke patient's prehospital condition. The models indicate that there is an optimal diagnostic time on the part of the dispatcher that minimizes the adverse consequences throughout the prehospital stages of care under disruptive events, and that a centralized system can mitigate a ripple effect in prehospital stroke care.