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For rich and poor, the message is still "dial 9-1-1": but is it getting through?

The mantra for public service announcements on stroke has included 911/Emergency Medical System (EMS) use as the first point of contact for patients with stroke symptoms for over 10 years. The rationale behind this is clear. As with chest pain and acute myocardial infarction, 911/EMS use by patients with symptoms of stroke represents an early component in the Chain of Recovery.1 Furthermore, a single message links the urgency of “heart attack” and “brain attack”: reinforcing and directing action by the lay public. Though the benefits of 911/EMS use accrue in both the prehospital and in-hospital settings, it is unclear whether this message is getting through.

In the prehospital arena, stroke patients using 911/EMS arrive to the emergency department faster in comparison to those calling their primary physician or driving to a hospital or primary care site directly. There is also a strong association between EMS use and shorter time periods from symptom onset to hospital arrival—though this likely reflects a greater sense of urgency on the patient’s or bystander’s part rather than reduced transport times. Additionally, almost 20% of patients with stroke symptoms have acute medical conditions requiring paramedic-level interventions in the field, including emergent airway management.2 …