Deandre Duggal

Abstract

Stroke remains a leading cause of death and long-term disability worldwide, with rapid recognition and timely treatment being critical determinants of recovery. Despite established guideline recommendations, fewer than two-thirds of patients experiencing stroke consistently use Emergency Medical Services (EMS) for hospital transport, resulting in treatment delays and increased risk of poor outcomes. This exploratory mixed-methods study examined the multifactorial reasons patients choose EMS versus private vehicle transport during stroke events. Conducted at the Henry Ford Health System Stroke/Telemetry Unit between September and October 2025, 51 participants completed structured surveys with optional open-ended questions exploring demographics, stroke knowledge, symptom perception, mode of transport, and barriers to EMS activation. Quantitative data were analyzed descriptively, while qualitative responses underwent coding to identify behavioral, social, and contextual influences. Results indicated that 56.9% of participants arrived by EMS and 41.2% by private vehicle; the mean age was 64.4 years, with 60.8% identifying as male. Most participants (86%) presented within one hour of symptom recognition, regardless of transport method, reflecting high awareness of urgency. Key motivators for EMS use included recognition of a medical emergency and external prompting, whereas self-transport was influenced by proximity to the hospital, perceived mildness of symptoms, and financial concerns. Qualitative analysis revealed five major themes: perceived urgency and fear, influence of others, uncertainty regarding symptom severity, financial and logistical considerations, and retrospective reflection on transport decisions. These findings align with recent literature linking social factors, neighborhood deprivation, and language barriers to delays in EMS utilization (Forman et al., 2024; Hazelton et al., 2024; Zhou et al., 2025). Targeted community interventions emphasizing BEFAST stroke recognition and the benefits of EMS transport, along with transparent education addressing cost and hospital destination concerns, may enhance timely care. Collectively, these results highlight that stroke response behavior is shaped by intersecting emotional, social, and systemic factors that extend beyond individual health literacy and underscore the need for multifaceted strategies to improve patient outcomes.