The effects of COVID-19 on the reasons for not calling 911 for acute stroke

Objective: Our Stroke Program regularly provides community outreach and stroke education The stroke team educates on signs and symptoms of stroke, risks factors, and 911 activation Within a few days of discharge, Neuroscience nurses call stroke patients to ensure patients have obtained their prescription medications, have follow-up appointments, inquire about their satisfaction with our services, and reinforce stroke education As part of these calls, our team asked why patients/families did not call 911 The purpose of this study was to determine if the COVID-19 crisis influenced the reasons why 911 was not called for possible stroke to better plan for targeted stroke education Method: Discharge phone survey data from our stroke network was collected from Feb-Jul 2019 and compared to Feb-Jul 2020 Our stroke network includes 1 comprehensive stroke center and 2 primary stroke centers Emergency Department (ED) stroke activation data was gathered for the same time periods Discharge phone calls data was based on discharge date, whereas ED stroke alert data was based on admission date Results: There was a notable decline in stroke volume between 2019 to 2020 with the largest decline occurring during the first peak (Apr 2020) in COVID-19 cases within our state This decline was driven by a 16% decline in walk-in ED stroke arrivals as compared to a 1% decline in EMS stroke arrivals Of those who did not call 911 in 2020, there was a 7% increase in failing to recognize stroke symptoms as an emergency, a 6% increase in concern about EMS cost, and 6% decrease in hospital preference Conclusion: The COVID-19 crisis negatively influenced stroke volumes within our system strokeprogram Reductions in stroke walk-ins accounted for this decline COVID-19 affected the reasonswhy 911 was not called The largest increase was in not recognizing stroke symptoms as anemergency and increased concern about EMS associated costs Surprisingly, COVID-19 was notlisted as a reasons for avoiding 911 Targeted community educational efforts on these concerns maylead to improved 911 usage for suspected stroke during the COVID-19 pandemic