Skip to main content
    • Aa
    • Aa

Relationship Between Time from Ambulance Call to Arrival at Emergency Center and Level of Consciousness at Admission in Severe Stroke Patients

  • Kazuhiro Ohwaki (a1), Takehiro Watanabe (a2), Takayuki Shinohara (a2), Tadayoshi Nakagomi (a2) and Eiji Yano (a1)...

Timely access to acute medical treatment can be critical for patients suffering from severe stroke. Little information is available about the impact of prehospital delays on the clinical conditions of stroke patients, but it is possible that prehospital delays lead to neurological deterioration. The aim of this study was to examine the impact of prehospital delays related to emergency medical services on the level of consciousness at admission in patients with severe stroke.


This retrospective study assessed 712 consecutive patients diagnosed with cerebrovascular diseases who were admitted to an intensive care unit in Tokyo, Japan, from April 1998 through March 2008. Data, including the time from the call to the ambulance service to the arrival of the ambulance at the patient location (on-scene), and the time from the arrival of the ambulance on-scene to its arrival at the emergency center were obtained. The following demographic and clinical information also were obtained from medical records: sex, age, and Glasgow Coma Scale (GCS) score at admission.


The mean time from ambulance call to arrival on-scene was 7 (SD=3) minutes, and the mean time from ambulance call to arrival at the center was 37 (SD=8) minutes. A logistic regression model for predicting GCS scores of 3 and 4 at admission was produced. After adjusting for sex, age, and time from arrival on-scene to arrival at the center, a longer call-to-on-scene time was significantly associated with poor GCS scores (OR = 1.056/min; 95% confidence interval, [CI] = 1.008-1.107). After adjusting for sex and age, a longer call-to-arrival at the center time also was significantly associated with poor GCS scores (OR = 1.020; 95% CI = 1.002-1.038).


Prehospital delays were significantly associated with decreased levels of consciousness at admission in patients suffering from a stroke. As level of consciousness is the strongest predictor of outcome, reducing prehospital delays may be necessary to improve the outcomes in patients with severe stroke.

OhwakiK, WatanabeT, ShinoharaT, NakagomiT, YanoE. Relationship Between Time from Ambulance Call to Arrival at Emergency Center and Level of Consciousness at Admission in Severe Stroke Patients. Prehosp Disaster Med. 2012;28(1):1-4.

Corresponding author
Correspondence: Kazuhiro Ohwaki, MD, PhD Department of Hygiene and Public Health Teikyo University School of Medicine 2-11-1 Kaga Itabashi Tokyo 173-8605, Japan E-mail
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1. H Wrigley , S George , H Smith , H Snooks , A Glasper , E Thomas . Trends in demand for emergency ambulance services in Wiltshire over nine years: observational study. BMJ. 2002;324(7338):646-647.

2. S Lambe , DL Washington , A Fink , et al. Trends in the use and capacity of California's emergency departments, 1990-1999. Ann Emerg Med. 2002;39(4):389-396.

5. M Holmberg , S Holmberg , J Herlitz . Incidence, duration and survival of ventricular fibrillation in out-of-hospital cardiac arrest patients in Sweden. Resuscitation. 2000;44(1):7-17.

6. HD White , RM Norris , MA Brown , et al. Effect of intravenous streptokinase on left ventricular function and early survival after acute myocardial infarction. N Engl J Med. 1987;317(14):850-855.

8. JR Marler , BC Tilley , M Lu , et al. Early stroke treatment associated with better outcome: The NINDS rt-PA stroke study. Neurology. 2000;55(11):1649-1655.

9. SA Mayer , NC Brun , K Begtrup , et al. Recombinant activated factor VII for acute intracerebral hemorrhage. N Engl J Med. 2005;352(8):777-785.

10. DO Kleindorfer , CJ Lindsell , JP Broderick , et al. Community socioeconomic status and prehospital times in acute stroke and transient ischemic attack: do poorer patients have longer delays from 911 call to the emergency department? Stroke. 2006;37(6):1508-1513.

11. CR Lacy , DC Suh , M Bueno , JB Kostis . Delay in presentation and evaluation for acute stroke: Stroke Time Registry for Outcomes Knowledge and Epidemiology (S.T.R.O.K.E.). Stroke. 2001;32(1):63-69.

12. KC Chang , MC Tseng , TY Tan . Prehospital delay after acute stroke in Kaohsiung, Taiwan. Stroke. 2004;35(3):700-704.

13. CB Hutchings , NC Mann , M Daya , et al. Patients with chest pain calling 9-1-1 or self-transporting to reach definitive care: which mode is quicker? Am Heart J. 2004;147(1):35-41.

14. KR Evenson , EB Schroeder , TB Legare , JH Brice , WD Rosamond , DL Morris . A comparison of emergency medical services times for stroke and myocardial infarction. Prehosp Emerg Care. 2001;5(4):335-339.

16. OM Rønning , B Guldvog . Should stroke victims routinely receive supplemental oxygen? A quasi-randomized controlled trial. Stroke. 1999;30(10):2033-2037.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Prehospital and Disaster Medicine
  • ISSN: 1049-023X
  • EISSN: 1945-1938
  • URL: /core/journals/prehospital-and-disaster-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 1
Total number of PDF views: 21 *
Loading metrics...

Abstract views

Total abstract views: 156 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 25th September 2017. This data will be updated every 24 hours.