International Comparison of Ambulance Time Intervals for Suspected Stroke/Transient Ischemic Attack Across 7 Emergency Medical Services Before and During the COVID-19 Pandemic.
Journal of the American Heart Association · 2026-08-27 · Quasi-experimental
Abstract
BACKGROUND: International reports highlight the COVID-19 pandemic's wide-ranging impacts on time-sensitive conditions, including stroke/transient ischemic attack (TIA). Comparing ambulance time intervals globally offers insights into COVID-19's effects on different health care systems. This study aimed to compare ambulance time intervals for adults with suspected stroke/TIA across 7 services before and during the COVID-19 pandemic. METHODS: We conducted a quasi-experimental before-and-after study examining the impact of COVID-19 on 5 ambulance time intervals and call volume for suspected stroke/TIA cases. International ambulance services using the Advanced Medical Priority Dispatch System provided data on all suspected stroke/TIA calls. Outcomes were compared between the pre-COVID-19 period (January 1, 2018, to the week before first identified case) and the COVID-19 period (first identified case to December 31, 2021) using descriptive, time-series, and regression analyses. RESULTS: Four national (Republic of Ireland, New Zealand, Northern Ireland, and Scotland) and 3 regional (Queensland, Tilburg, and Vienna) services provided data on 273 362 suspected stroke/TIA cases. No consistent effect was observed on allocation performance, mobilization performance, or conveyance time. Mean response time increased significantly in all services (0.5-9.13 minutes) except New Zealand, where it decreased by 1.57 minutes. Mean on-scene time increased significantly across all services (1.05-3.78 minutes). Mean monthly call volume per 1000 emergency calls increased significantly in 6 services (16-40.5 cases), whereas the Netherlands showed no change. CONCLUSIONS: Aligning time interval definitions across 7 ambulance services highlighted response and on-scene times as key contributors to prehospital delays during the pandemic. Future interventions should focus on these prehospital phases, particularly during times of increased pressure on the health care system.