ArticlePrehospital emergency care2025
Rural Emergency Medical Services Perspectives on Improving Acute Stroke Care: A Qualitative Study.
Article in Prehospital emergency care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
2 citing papers in PubMed.
- Robot-Assisted Mechanical Thrombectomy for Neurointerventional Surgery: An Exploratory Scoping Review.Journal of robotic surgery · 2026Article
- Stroke Survivor and Caregiver Perspectives on Seeking Emergency Medical Care.Journal of patient experience · 2026Article
Corrections and comments
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Authors and funding
8 authors.
Funding
Abstract
objectivesFor underserved rural communities with limited geographical access to comprehensive stroke centers, emergency medical services (EMS) play a crucial role in timely, high-quality acute stroke care. This qualitative study aimed to understand rural EMS perspectives on barriers and facilitators to optimal acute stroke care in rural communities.
methodsQualitative, individual semi-structured interviews were conducted with rural EMS professionals. Ten EMS agencies in North Carolina were contacted for participation in virtual 45-60 minute interviews and interested agency professionals self-selected into the study. Covered topics included stroke training and education; stroke care experience and expertise; clinical and sociodemographic patient characteristics; EMS workflows; and system- and patient-level interactions and outcomes. Recorded interviews were transcribed and then coded using an inductive and deductive, iterative approach by two independent reviewers in MAXQDA software. Facilitators and barriers to optimal acute stroke care were derived from thematic analysis.
resultsTwelve EMS professionals from 4 rural EMS agencies and 1 mixed urban-rural agency were interviewed. Participants worked in clinical (6 Paramedics, 1 EMT) and leadership (2 chiefs, 1 supervisor, 1 field training officer, 1 quality assurance manager) roles for a mean of 4 years (range 1-11 years). Commonly noted facilitators of high-quality stroke care were comprehensive stroke assessment and destination decision protocols, as well as bidirectional communication between EMS and hospital staff. Identified barriers included patient and bystander delays in calling 9-1-1, long transport distances to stroke centers, and limited EMS staffing. EMS professionals noted challenges interacting with nursing home staff and hospital clinicians during patient transfer. Interviewees also discussed the importance of educating the public about stroke signs and symptoms and community engagement.
conclusionsWithin rural populations, EMS professionals determined that public education and community engagement are high-priority needs. Professionals also noted EMS' opportunities to enhance rural stroke care through consistent bidirectional communication and improved prehospital protocols. Future research is needed to further explore these themes in rural EMS agencies outside of North Carolina.
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