During the study period, 1082 patients with acute stroke and acute myocardial infarction were admitted to our hospital. Among them, 582 patients had acute cerebral infarction, 354 patients had acute cerebral hemorrhage, 48 patients had acute spontaneous subarachnoid hemorrhage, and 98 patients had acute myocardial infarction. However, a total of 153 patients were excluded from the study for various reasons, including unwillingness to participate in the questionnaire survey, failure of the investigator to complete the survey, invalid questionnaires, and patients with acute stroke or acute myocardial infarction who had started treatment outside of Zhongjiang County and were subsequently transferred to our hospital, as they met the exclusion criteria. The final result was that we collected 929 valid questionnaires. Among them, 243 (26.16%) called for EMS (EMS-activation group), while the remaining did not call for EMS (self-transportation group).
3.1 Social demographics, cardiovascular history, risk factors
Table 1 lists social demographics, cardiovascular history, risk factors in the overall population and comparison between EMS-activation group and self-transportation group. No statistical differences were observed in age, gender, educational level, marriage status, risk factors and previous cardiovascular or cerebrovascular diseases. Only the answers regarding whether they have ever received first aid education showed statistical differences between the two groups. The self-transportation group was more likely to report not knowing the 120 emergency phone number (11.4% vs 6.2% P = 0.02), whereas the EMS-activation group was more likely to have studied first aid through media or the Internet (9.5% vs 5.2% P = 0.02).
Table 1
Social demographics, cardiovascular history, risk factors in the overall population and comparison between EMS-activation group and self-transportation group
| Variable | Overall | EMS activation | Self-transported | p Value |
| Age, years [IQR] | 71[61–78] | 71[62–80] | 71[61–78] | 0.49 |
| Sex (male), n (100%) | 505(54.4%) | 129(53.1%) | 376(54.8%) | 0.64 |
| Educational level | | | | 0.17 |
| primary school | 565(60.8%) | 136(56.0%) | 429(62.5%) | |
| junior middle school | 125(13.5%) | 37(15.2%) | 88(12.8%) | |
| senior middle school and above | 49(5.3%) | 18(7.4%) | 31(4.5%) | |
| I haven't been to school | 190(20.5%) | 52(21.4%) | 138(20.1%) | |
| Marriage status | | | | 0.08 |
| single(unmarried, divorced, widowed), n (100%) | 179(19.3%) | 56(23.0%) | 123(17.9%) | |
| married, n (%) | 750(80.7%) | 187(77.0%) | 563(82.1%) | |
| n (100%) | | | | |
| diabetes mellitus | 175(18.8%) | 45(18.5%) | 130(19.0%) | 0.88 |
| hypertension | 600(64.6%) | 161(66.3%) | 439(64.0%) | 0.53 |
| dyslipidemia | 42(4.5%) | 13(5.3%) | 29(4.2%) | 0.47 |
| familiar history | 44(4.7%) | 12(4.9%) | 32(4.7%) | 0.86 |
| smoking | 241(25.9%) | 68(28.0%) | 173(25.2%) | 0.40 |
| no | 180(19.4%) | 40(16.5%) | 140(20.4%) | 0.18 |
| Previously suffered from cardiovascular and cerebrovascular diseases, n (100%) | 244(26.3%) | 64(26.3%) | 180(26.2%) | 0.98 |
| the question of whether you have ever received first aid education, n (100%) | | | | |
| no, I didn't even know the 120 emergency phone number | 93(10.0%) | 15(6.2%) | 78(11.4%) | 0.02 |
| I only know that I can call 120 when you need first aid | 752(80.9%) | 199(81.9%) | 553(80.6%) | 0.66 |
| I had studied it in my school education courses | 51(5.5%) | 10(4.1%) | 41(6.0%) | 0.27 |
| I had studied in the media and on the Internet | 59(6.4%) | 23(9.5%) | 36(5.2%) | 0.02 |
3.2 Understandings of cardiovascular and cerebrovascular diseases
Table 2 lists understandings of cardiovascular and cerebrovascular diseases in the overall population and comparison between EMS-activation group and self-transportation group. The EMS-activation group was more likely to believe that cardiovascular and cerebrovascular diseases have symptoms such as disorders of consciousness or convulsions (11.1% vs 6.7% p = 0.03) and chest pressure (7.8% vs 3.8% p = 0.02). In addition, it is worth noting that 42.1% of them reported that they had no understanding of cardiovascular and cerebrovascular diseases.
Table 2
understandings of diseases in the overall population and comparison between EMS-activation group and self-transportation group (sorted by overall from high to low)
| Variable, n (100%) | Overall | EMS activation | Self-transported | p Value |
| I have no understanding of cardiovascular and cerebrovascular diseases | 391(42.1%) | 98(40.3%) | 293(42.7%) | 0.52 |
| one side of the limb is weak, numb, and clumsy | 279(30.0%) | 66(27.2%) | 213(31.0%) | 0.26 |
| poor speaking or difficulty in understanding the language | 151(16.3%) | 42(17.3%) | 109(15.9%) | 0.61 |
| one side of the face numbness or askew of the mouth | 125(13.5%) | 30(12.3%) | 95(13.8%) | 0.56 |
| headache | 109(11.7%) | 36(14.8%) | 73(10.6%) | 0.08 |
| headache associated with nausea and vomiting | 101(10.9%) | 24(9.9%) | 77(11.2%) | 0.56 |
| dizziness | 84(9.0%) | 23(9.5%) | 61(8.9%) | 0.79 |
| chest pain | 81(8.7%) | 19(7.8%) | 62(9.0%) | 0.56 |
| disorders of consciousness or convulsions | 73(7.9%) | 27(11.1%) | 46(6.7%) | 0.03 |
| weakness and asthenia | 65(7.0%) | 19(7.8%) | 46(6.7%) | 0.56 |
| dyspnea | 62(6.7%) | 20(8.2%) | 42(6.1%) | 0.26 |
| vertigo associated with nausea and vomiting | 57(6.1%) | 18(7.4%) | 39(5.7%) | 0.34 |
| nausea, vomiting | 48(5.2%) | 18(7.4%) | 30(4.4%) | 0.07 |
| chest pressure | 45(4.8%) | 19(7.8%) | 26(3.8%) | 0.01 |
| stomach burning | 27(2.9%) | 8(3.3%) | 19(2.8%) | 0.67 |
| optic rotation or balance disorder | 24(2.6%) | 6(2.5%) | 18(2.6%) | 0.9 |
| other | 23(2.5%) | 5(2.1%) | 18(2.6%) | 0.63 |
| sweating | 21(2.3%) | 8(3.3%) | 13(1.9%) | 0.21 |
| left arm pain or shake | 16(1.7%) | 4(1.6%) | 12(1.7%) | 1.00 |
| loss or blurred vision on either one side or both eyes | 16(1.7%) | 4(1.6%) | 12(1.7%) | 1.00 |
| both eyes are fixed and can not rotate | 10(1.1%) | 3(1.2%) | 7(1.0%) | 0.73 |
3.3 Symptom characteristics
Table 3 lists symptom characteristics when the symptoms occurred in the overall population and comparison between the two groups. The most common symptom in patients with acute stroke was that one side of the limb is weak or numb or clumsy, which occurs in 58.0% of cases. Meanwhile, chest pain was the most common symptom occurring in 73.3% of patients with acute myocardial infarction. One side of the limb is weak or numb or clumsy (50.7% vs 60.7%, p < 0.01) was associated with decreased use of ambulance. At the same time, chest pain(78.6% vs 50.0%, p = 0.03) was associated with increased use of ambulance.
Table 3
Symptom characteristics when the symptoms occurred in the overall population and comparison between the two groups
| Variable, n (100%) | Overall | EMS activation | Self-transported | p Value | |
| Acute stroke | | | | | |
| one side of the limb is weak, numb, and clumsy | 489(58.0%) | 115(50.7%) | 374(60.7%) | < 0.01 | |
| poor speaking or difficulty in understanding the language | 319(37.8%) | 91(40.1%) | 228(37.0%) | 0.41 | |
| one side of the face numbness or askew of the mouth | 192(22.8%) | 47(20.7%) | 145(23.5%) | 0.38 | |
| headache | 151(17.9%) | 47(20.7%) | 104(16.9%) | 0.20 | |
| dizziness | 148(17.6%) | 35(15.4%) | 113(18.3%) | 0.32 | |
| headache associated with nausea and vomiting | 101(12.0%) | 46(20.3%) | 55(8.9%) | < 0.001 | |
| disorders of consciousness or convulsions | 91(10.8%) | 50(22.0%) | 41(6.7%) | < 0.001 | |
| vertigo associated with nausea and vomiting | 88(10.4%) | 24(10.6%) | 64(10.4%) | 0.94 | |
| optic rotation or balance disorder | 60(7.1%) | 13(5.7%) | 47(7.6%) | 0.34 | |
| loss or blurred vision on either one side or both eyes | 15(1.8%) | 8(3.5%) | 7(1.1%) | 0.03 | |
| both eyes are fixed and can not rotate | 3(0.4%) | 2(0.9%) | 1(0.2%) | 0.18 | |
| other | 51(6.0%) | 20(8.8%) | 31(5.0%) | | |
| Acute myocardial infarction | | | | | |
| chest pain | 63(73.3%) | 8(50.0%) | 55(78.6%) | 0.03 |
| grade of chest pain | | | | 0.09 |
| mild (grade 1/2/3) | 11(17.5%) | 2(25.0%) | 9(16.4%) | |
| moderate (grade 4/5/6) | 22(34.9%) | 0(0.0%) | 22(40.0%) | |
| severe (grade 7/8/9/10) | 30(47.6%) | 6(75.0%) | 24(43.6%) | |
| sweating | 34(39.5%) | 6(37.5%) | 28(40.0%) | 0.85 |
| chest pressure | 25(29.1%) | 5(31.2%) | 20(28.6%) | 1.00 |
| dyspnea | 23(26.7%) | 5(31.2%) | 18(25.7%) | 0.76 |
| nausea, vomiting | 14(16.3%) | 5(31.2%) | 9(12.9%) | 0.13 |
| dizziness | 10(11.6%) | 3(18.8%) | 7(10.0%) | 0.39 |
| tired | 8(9.3%) | 2(12.5%) | 6(8.6%) | 0.64 |
| stomach burning | 5(5.8%) | 0(0.0%) | 5(7.1%) | 0.58 |
| left arm pain or shake | 3(3.5%) | 0(0.0%) | 3(4.3%) | 1.00 |
3.4 The situation when the symptoms occurred
Table 4 lists informations regarding the situation when the symptoms occurred in the overall population and comparison between the two groups. The median time of calling 120 and hospital arrival(if not called) from the symptoms occurred in EMS-activation group was 2.0 hours, whereas in the self-transportation group, the median time was 5.0 hours, with p < 0.001. Patients diagnosed with acute cerebral hemorrhage (43.6% vs 26.7%) and acute spontaneous subarachnoid hemorrhage (5.8% vs 2.2%) exhibited significantly higher utilization of ambulances compared to those diagnosed with acute cerebral infarction (44.0% vs 60.9%) and acute myocardial infarction (6.6% vs 10.2%), with a statistically significant difference (p < 0.001).
Table 4
informations regarding the situation when the symptoms occurred in the overall population and comparison between the two groups
| Variable | Overall | EMS activation | Self-transported | p Value |
| The time of calling 120 and hospital arrival(if not called), hours [IQR] | 4.00[1.50-13.17] | 2.00[0.67-5.00] | 5.00[2.00-18.54] | < 0.001 |
| Diagnosis, n (100%) | | | | < 0.001 |
| acute cerebral infarction | 525(56.5%) | 107(44.0%) | 418(60.9%) | |
| acute cerebral hemorrhage | 289(31.1%) | 106(43.6%) | 183(26.7%) | |
| acute spontaneous subarachnoid hemorrhage | 29(3.1%) | 14(5.8%) | 15(2.2%) | |
| acute myocardial infarction | 86(9.3%) | 16(6.6%) | 70(10.2%) | |
| Time of symptom onset, n (100%) | | | | < 0.01 |
| 1 am–4 am | 71 (7.6%) | 21 (8.6%) | 50 (7.3%) | |
| 5 am–8 am | 230 (24.8%) | 45 (18.5%) | 185 (27.0%) | |
| 9 am–12 pm | 242 (26.0%) | 70 (28.8%) | 172 (25.1%) | |
| 13 pm–16 pm | 160 (17.2%) | 33 (13.6%) | 127 (18.5%) | |
| 17 pm–20 pm | 157 (16.9%) | 55 (22.6%) | 102 (14.9%) | |
| 21 pm–0 am | 69 (7.4%) | 19 (7.8%) | 50 (7.3%) | |
| When the patient had these symptoms, kilometers [IQR] | | | | |
| the distance between the patient and the nearest township hospital | 2[1–5] | 2[1–5] | 3[1–5] | 0.03 |
| the distance between the patient and the nearest first aid station (the 120 network hospital) | 12[4–20] | 10[2–18] | 14[5–20] | < 0.001 |
| the distance between the patient and the people's hospital of Zhongjiang | 20[6.5–38.5] | 15[3–30] | 20[10–40] | < 0.001 |
| Where was the patient when these symptoms occur? n (100%) | | | | 0.03 |
| home | 750(80.7%) | 183(75.3%) | 567(82.7%) | |
| public place | 76(8.2%) | 28(11.5%) | 48(7.0%) | |
| in the work or in the labor | 52(5.6%) | 14(5.8%) | 38(5.5%) | |
| with relatives or friends | 22(2.4%) | 5(2.1%) | 17(2.5%) | |
| other | 29(3.1%) | 13(5.3%) | 16(2.3%) | |
| Who was there when the patient was symptomatic? | | | | |
| the patient's wife or husband / patient's partner | 419(45.1%) | 99(40.7%) | 320(46.6%) | 0.11 |
| the patient's son or daughter | 261(28.1%) | 60(24.7%) | 201(29.3%) | 0.17 |
| not a soul | 184(19.8%) | 55(22.6%) | 129(18.8%) | 0.20 |
| friends of the patient | 62(6.7%) | 17(7.0%) | 45(6.6%) | 0.82 |
| colleagues of the patient's work | 19(2.0%) | 5(2.1%) | 14(2.0%) | 1.00 |
| others | 61(6.6%) | 22(9.1%) | 39(5.7%) | 0.07 |
| Who realized the serious problem before making an emergency call or going to the hospital? | | | | < 0.001 |
| relatives | 679(73.1%) | 188(77.4%) | 491(71.6%) | |
| the patient | 129(13.9%) | 15(6.2%) | 114(16.6%) | |
| friend | 41(4.4%) | 16(6.6%) | 25(3.6%) | |
| not a soul | 29(3.1%) | 3(1.2%) | 26(3.8%) | |
| doctors in a private practice | 12(1.3%) | 5(2.1%) | 7(1.0%) | |
| other | 39(4.2%) | 16(6.6%) | 23(3.3%) | |
| Where did the patient go in the first time? | | | | 0.08 |
| the people's hospital of Zhongjiang | 597(64.3%) | 164(67.5%) | 433(63.1%) | |
| nearby township health center | 202(21.7%) | 46(18.9%) | 156(22.7%) | |
| private practice, individual doctors | 42(4.5%) | 5(2.1%) | 37(5.4%) | |
| hospital near | 32(3.4%) | 13(5.3%) | 19(2.8%) | |
| other hospitals with a chest pain center / stroke center | 18(1.9%) | 4(1.6%) | 14(2.0%) | |
| other | 38(4.1%) | 11(4.5%) | 27(3.9%) | |
| Who had decided that the patient needed further medical help? | | | | < 0.001 |
| the patient's son or daughter | 489(52.6%) | 129(53.1%) | 360(52.5%) | |
| the patient's wife or husband / patient's partner | 171(18.4%) | 44(18.1%) | 127(18.5%) | |
| doctor from a nearby township hospital | 92(9.9%) | 25(10.3%) | 67(9.8%) | |
| the patient | 79(8.5%) | 5(2.1%) | 74(10.8%) | |
| friends of the patient | 17(1.8%) | 9(3.7%) | 8(1.2%) | |
| other doctor | 14(1.5%) | 4(1.6%) | 10(1.5%) | |
| private clinic | 10(1.1%) | 1(0.4%) | 9(1.3%) | |
| colleagues of the patient's work | 9(1.0%) | 3(1.2%) | 6(0.9%) | |
| other | 48(5.2%) | 23(9.5%) | 25(3.6%) | |
| If the patient didn't seek help immediately after symptoms, what caused you to do so? | | | | < 0.001 |
| we sought medical attention immediately after the symptoms appeared and did not wait | 549(59.1%) | 184(75.7%) | 365(53.2%) | |
| think the symptoms will disappear spontaneously | 144(15.5%) | 18(7.4%) | 126(18.4%) | |
| think they are not important symptoms | 138(14.9%) | 16(6.6%) | 122(17.8%) | |
| don't want to disturb others | 24(2.6%) | 1(0.4%) | 23(3.4%) | |
| think it's not a heart or brain problem | 16(1.7%) | 5(2.1%) | 11(1.6%) | |
| the symptoms are unstable | 7(0.8%) | 1(0.4%) | 6(0.9%) | |
| I hope to consult the doctor that I know well first | 6(0.6%) | 1(0.4%) | 5(0.7%) | |
| fear | 4(0.4%) | 1(0.4%) | 3(0.4%) | |
| previous negative experiences with the hospital | 2(0.2%) | 0(0.0%) | 2(0.3%) | |
| other | 39(4.2%) | 16(6.6%) | 23(3.4%) | |
The distribution of symptom onset times among patients also had statistically significant implications for their decision to call an ambulance (p < 0.01). There were higher numbers of ambulance calls from 17 pm to 20 pm (22.6% vs 14.9%), 21 pm to midnight (7.8% vs 7.3%), 1 am to 4 am (8.6% vs 7.3%), and 9 am to 12 pm (28.8% vs 25.1%). Conversely, lower numbers of ambulance calls were observed between 5 am and 8 am (18.5% vs 27.0%), 13 pm and 16 pm (13.6% vs 18.5%).
When the patient had these symptoms, the median distance to the nearest township hospital was 2 kilometers for the EMS-activation group and 3 kilometers for the self-transportation group (p = 0.03). The median distance between the patient and the nearest 120 network hospital was 10 kilometers for the EMS-activation group and 14 kilometers for the self-transportation group (p < 0.001). Meanwhile, the median distance between the patient and the people's hospital of Zhongjiang was 15 kilometers for the EMS-activation group and 20 kilometers for the self-transportation group (p < 0.001).
When asked where was the patient when these symptoms occur, patients who were in a public place (11.5% vs 7.0%) had a higher utilization of ambulance services compared to those who were at home (75.3% vs 82.7%) (p = 0.03).
Before making an emergency call or going to the hospital, the patient's relatives (77.4% vs 71.6%), friend (6.6% vs 3.6%), doctors in a private practice (2.1% vs 1.0%), and other individual (6.6% vs 3.3%) who realized that this was a serious problem were associated with increased use of ambulance compared to the patient (6.2% vs 16.6%), and not a soul (1.2% vs 3.8%) (p < 0.001). While, when doctor from a nearby township hospital (10.3% vs 9.8%), other doctor (1.6% vs 1.5%), the patient's friends (3.7% vs 1.2%), colleagues (1.2% vs 0.9%), and other individual (9.5% vs 3.6%) who decided that the patient needed further medical help, there were higher numbers of ambulance calls than the patient (2.1% vs 10.8%), the patient's partner (18.1% vs 18.5%), and private clinic (0.4% vs 1.3%) (p < 0.001).
When asked what caused them not to seek help immediately after symptoms appeared, the self-transportation group was more likely to believe that the symptoms would disappear spontaneously (18.4% vs 7.4%), they were not important symptoms (17.8% vs 6.6%), didn't want to disturb others(3.4% vs 0.4%) compare to the EMS-activation group. While, the EMS-activation group was even more likely to think that it wasn't a heart or brain problem (2.1% vs 1.6%) (p < 0.001).
3.5 Information of the self-transportation group: How to hospital, Reasons, Choices and strategies for future situations
Table 5 lists Informations about how patients arrived at the hospital, their reasons for this choice, and their actions if such a situation were to occur again among the 686 patients in the self-transportation group. The results of the survey show that the majority of patients arrive at the hospital by private transportation, either driven by a relative or friend (56.6%) or by the patient themselves (24.2%). Meanwhile, a minority chose to charter a private vehicle (11.5%).
Table 5
Informations about how patients arrived at the hospital, their reasons for this choice, and their actions if such a situation were to occur again among those who self-transport.
| Variable | Overall |
| How did the patient get to the hospital?, n (100%) | |
| the private transport driven by the patient's relative / friend | 388(56.6%) |
| the private transport driven by the patient | 166(24.2%) |
| chartered a private vehicle | 79(11.5%) |
| other | 53(7.7%) |
| Why don't you call 120?, n (100%) | |
| I believed that a private transport was much faster | 267(38.9%) |
| I didn't think this was a health problem serious enough to be called 120 | 171(24.9%) |
| I didn't think of it | 92(13.4%) |
| I was already in a private vehicle | 64(9.3%) |
| I wanted to choose the hospital by myself | 20(2.9%) |
| I didn't know how to dial 120 | 11(1.6%) |
| I didn't want to disturb others | 5(0.7%) |
| I didn't think 120 could help me | 1(0.1%) |
| other | 55(8.0%) |
| I believed that a private transport was much faster | 267(38.9%) |
| I didn't think this was a health problem serious enough to be called 120 | 171(24.9%) |
| If the time goes back when the patient first became ill, or if the patient experiences the same symptoms again, will you call 120 or go back to the hospital through private transportation?, n (100%) | |
| I will call the 120 | 311(45.3%) |
| I will still go to the hospital through private transportation | 373(54.4%) |
| other | 2(0.3%) |
| Why again with a private vehicle, n (100%) | |
| It's faster to drive by yourself | 229(73.2%) |
| It's more convenient to drive by yourself | 84(26.8%) |
| Thinking the disease is not serious | 40(12.8%) |
| Driving by yourself is more economical | 9(2.9%) |
| other | 11(3.5%) |
| Why again with calling the 120, n (100%) | |
| The medical staff in the ambulance are more professional | 91(29.1%) |
| Ambulance is faster | 80(25.6%) |
| Thinking the disease is serious | 68(21.7%) |
| Convenient ambulance | 28(8.9%) |
| other | 46(14.7%) |
When asked why they didn't call 120 EMS, the most common reasons were that patients believed a private transport would be faster (38.9%), they didn't think the health issue was severe enough to require an ambulance (24.9%), some patients didn't consider it (13.4%), and some were already in a private vehicle (9.3%).
When asked if they would call 120 or use private transportation to return to the hospital in the event that the time were to go back and the patients became ill again or displayed the same symptoms, the results were that 45.3% would call 120, while 54.4% would still choose private transportation to go to the hospital. The main reason for preferring private transportation was that it was faster (73.2%), more convenient (26.8%), or patients thought that the disease wasn't serious (12.8%). Some also believed that driving themselves was more economical (2.9%). For those who would call 120 again, the top reasons were that the medical staff in the ambulance was more professional (29.1%) and that ambulance was faster (25.6%). Other reasons included thinking the disease was serious (21.7%), believing the ambulance service more convenient (8.9%).
3.6 Result of Lasso regression analysis
Figure 2 demonstrates the results of LASSO regression analysis, which was performed to screen variates to avoid overfitting and to generate a simpler interpreted model. Finally, 32 prognostic variates were selected, including diagnosis, the distance between the patient and the nearest 120 network hospital, the distance between the patient and the people's hospital of Zhongjiang, the question of whether you have ever received first aid education (I didn't even know the 120 emergency phone number, I had studied it in my compulsory education courses, I had studied in the media and on the Internet), the understanding of the symptoms of cardiovascular and cerebrovascular diseases prior to this illness (chest pressure, headache, headache associated with nausea and vomiting, one side of the face numbness or askew of the mouth, both eyes are fixed and can not rotate, disorders of consciousness or convulsions, having no understanding of cardiovascular and cerebrovascular diseases), the symptoms experienced by the patient with acute myocardial infarction(chest pressure, sweating, nausea and vomiting), grades of chest pain, the symptoms experienced by the patient with acute stroke(headache, headache associated with nausea and vomiting, dizziness, one side of the limb is weak or numb or clumsy, loss or blurred vision on either one side or both eyes, optic rotation or balance disorder, disorders of consciousness or convulsions), the place where the patient was when these symptoms occur, the person who was there when the patient was symptomatic(not a soul, the patient's son or daughter), the person who realized that the problem was serious before making an emergency call or going to the hospital, the place where the patient sought medical attention in the first instance, the person who had decided that the patient needed further medical help, the reasons that caused the patient didn't seek help immediately after symptoms.
The final result of multivariable logistic regression analysis
3.7 Result of multivariable logistic regression analysis
Table 6 lists the final result of multivariable logistic regression analysis. It showed that diagnosed as acute myocardial infarction (OR 0.22, 95%CI 0.06 to 0.88) or acute cerebral infarction (OR 0.26, 0.10 to 0.68), the distance between the patient and the nearest 120 network hospital when the patient had these symptoms (OR 0.97, 0.94 to 0.99), the patient believed that the symptoms of cardiovascular and cerebrovascular diseases included headache accompanied by nausea and vomiting(OR 0.35, 0.18 to 0.69), one side of the face numbness or askew of the mouth (OR 0.51, 0.28 to 0.91) before the onset of this illness, the patient's son or daughter was there when the patient was symptomatic (OR 0.58, 0.37 to 0.94), the patient (OR 0.19, 0.05 to 0.72) and the patient's partner (wife or husband) (OR 0.36, 0.16 to 0.85) had decided that the patient needed further medical help, Among patients who did not seek immediate help after symptom onset, thinking that the symptoms will disappear spontaneously (OR 0.34, 0.13 to 0.92) or not wanting to disturb others (OR 0.06, 0.01 to 0.66) or believing that they are not important symptoms (OR 0.15, 0.05 to 0.42) were factors independently associated with less ambulance use. Age (OR 1.02, 1.00 to 1.04), Stroke patients have experienced symptoms of disturbance of consciousness or convulsions (OR 2.99, 1.72 to 5.2) were independent factors associated with increased ambulance use. The model is statistically significant with a p-value less than 0.001, and it’s Nagelkerke's R2 is 0.34. Meanwhile, the model's overall comprehensive prediction accuracy is 80.0% (for the self-transportation group, the prediction accuracy is 93.9%, while, for the EMS-activation group is 40.7%).
Table 6
Independent factors associated with choosing or not choosing ambulance in patients with acute stroke and acute myocardial infarction
| OR | OR | 95%CI | p Value |
| Diagnosis, acute myocardial infarction | 0.22 | 0.06 to 0.88 | 0.03 |
| Diagnosis, acute cerebral infarction | 0.26 | 0.10 to 0.68 | 0.01 |
| When the patient had these symptoms, the distance between the patient and the nearest first aid station | 0.97 | 0.94 to 0.99 | 0.01 |
| Age | 1.02 | 1.00 to 1.04 | 0.03 |
| Before the onset of this illness, the patient believed that the symptoms of cardiovascular and cerebrovascular diseases included headache accompanied by nausea and vomiting. | 0.35 | 0.18 to 0.69 | < 0.01 |
| Before the onset of this illness, the patient believed that the symptoms of cardiovascular and cerebrovascular diseases included one side of the face numbness or askew of the mouth | 0.51 | 0.28 to 0.91 | 0.02 |
| Stroke patients have experienced symptoms of disturbance of consciousness or convulsions | 2.99 | 1.72 to 5.2 | < 0.001 |
| Who was there when the patient was symptomatic? the patient's son or daughter | 0.58 | 0.37 to 0.94 | 0.03 |
| Who had decided that the patient needed further medical help? | | | |
| the patient | 0.19 | 0.05 to 0.72 | 0.01 |
| the patient's wife or husband / patient's partner | 0.36 | 0.16 to 0.85 | 0.02 |
| If the patient didn't seek help immediately after symptoms, what caused you to do so? | | | |
| think the symptoms will disappear spontaneously | 0.34 | 0.13 to 0.92 | 0.03 |
| don't want to disturb others | 0.06 | 0.01 to 0.66 | 0.02 |
| think they are not important symptoms | 0.15 | 0.05 to 0.42 | < 0.001 |