The Effectiveness Of Pre-Hospital Red Crescent Interventions In Myocardial Infarction And Stroke: A Systematic Review And Meta-Analysis Of Response Time, Treatment Time, And Clinical Outcomes

Abstract

Background: Myocardial infarction (MI) and stroke are among the leading global causes of death and disability, where timely intervention is crucial. The Red Crescent, as the primary emergency medical service provider across the Middle East and North Africa, plays a central role in pre-hospital care. However, the effectiveness of its interventions on response time, treatment delay, and patient outcomes has not been comprehensively evaluated.

Objectives: This systematic review and meta-analysis aimed to assess the effectiveness of pre-hospital Red Crescent interventions in patients with MI and stroke, focusing on response times, treatment times, and clinical outcomes.

Methods: Following PRISMA 2020 guidelines, a systematic search was conducted in PubMed, Scopus, Web of Science, Embase, Cochrane Library, and regional databases (2000–2025). Eligible studies included randomized controlled trials, cohorts, registries, and cross-sectional designs that evaluated Red Crescent or equivalent EMS interventions in MI and stroke. Outcomes of interest included EMS response time, on-scene time, door-to-needle (DTN) and door-to-balloon (D2B) times, mortality, and functional recovery. Random-effects meta-analyses were performed using RevMan 5.4 and Stata 17.

Results: From 2,388 identified records, 32 studies met inclusion criteria, covering over 1.2 million patients across multiple regions, including Saudi Arabia, Iran, UAE, Egypt, and Jordan. Pre-hospital 12-lead ECG acquisition and direct catheterization lab activation reduced D2B times by 30–60 minutes and significantly decreased short-term mortality (OR 0.72; 95% CI 0.61–0.85). EMS prenotification for stroke patients reduced DTN times by 20–34% and was associated with higher thrombolysis rates and lower in-hospital mortality (OR 0.87; 95% CI 0.76–0.98). Mobile Stroke Units, though limited in availability, further shortened onset-to-needle times (~30 minutes) and improved 90-day functional independence. Despite these benefits, Red Crescent registries revealed operational challenges: prolonged on-scene times (>15 minutes in 55% of missions), EMS response times averaging 9–15 minutes (above benchmarks), and low EMS utilization for STEMI (3–10% of patients).

Conclusion: Pre-hospital Red Crescent interventions, particularly early ECG acquisition, EMS prenotification, and stroke/STEMI codes, significantly improve treatment times and clinical outcomes in MI and stroke. However, underutilization of EMS services, prolonged on-scene times, and gaps in provider training remain critical barriers. Strengthening Red Crescent protocols, workforce training, and hospital integration could translate time savings into substantial improvements in survival and recovery for cardiovascular emergencies.