The data suggest that prehospital stroke care in STEMO is feasible. No safety concerns have been raised so far. This new approach using prehospital tPA may be effective in reducing call-to-needle times, but this is currently being scrutinized in a prospective controlled study.

Background and Purpose-Recent innovations such as CT installation in ambulances may lead to earlier start of stroke-specific treatments. However, such technically complex mobile facilities require effective methods of correctly identifying patients before deployment. We aimed to develop and validate a new dispatcher identification algorithm for stroke emergencies. Methods-Dispatcher identification algorithm for stroke emergencies was informed by systematic qualitative analysis of the content of emergency calls to ambulance dispatchers for patients with stroke or transient ischemic attack (Nϭ117) and other neurological (Nϭ39) and nonneurological (Nϭ51) diseases (Part A). After training of dispatchers, sensitivity and predictive values were determined prospectively in patients admitted to Charité hospitals by using the discharge diagnosis as reference standard (Part B). Results-Part A: Dysphasic/dysarthric symptoms (33%), unilateral symptoms (22%) and explicitly stated suspicion of stroke (47%) were typically identified in patients with stroke but infrequently in nonstroke cases (all Ͻ10%). Convulsive symptoms (41%) were frequent in other neurological diseases but not strokes (3%). Pain (26%) and breathlessness (31%) were often expressed in nonneurological emergencies (6% and 7% in strokes). Part B: Between October 15 and December 16, 2010, 5774 patients were admitted by ambulance with 246 coded with final stroke diagnoses. Sensitivity of dispatcher identification algorithm for stroke emergencies for detecting stroke was 53.3% and positive predictive value was 47.8% for stroke and 59.1% for stroke and transient ischemic attack. Of all 275 patients with stroke dispatcher codes, 215 (78.5%) were confirmed with neurological diagnosis. Conclusions-Using dispatcher identification algorithm for stroke emergencies, more than half of all patients with stroke admitted by ambulance were correctly identified by dispatchers. Most false-positive stroke codes had other neurological diagnoses. (Stroke. 2012;43:776-781.)Key Words: algorithm Ⅲ diagnostic accuracy Ⅲ dispatch Ⅲ sensitivity Ⅲ specificity Ⅲ stroke E ffective acute stroke therapies such as intravenous thrombolysis and stroke unit treatment have been established over the last decades. 1 However, these treatment options are not available in all hospitals 1 and the effect of thrombolysis on functional outcome is time-dependent. 2,3 Early recognition of patients with acute stroke in the prehospital setting is helpful in triaging patients and increasing admission rates of patients with stroke to specialized facilities. Prehospital stroke scores have been developed to assist in identifying stroke and show acceptable sensitivity (between 66% and 91%) and positive predictive values (78% and 90%). 4 -7 These scores were tested with medical professionals in primary care, emergency medical services (EMS), and emergency department physicians. 7 Recent developments such as the installation of a CT scanner and point-of-care laboratory in EMS ambulances 8,9 promise a complete diagno...

The prevalence of obesity is high in Germany, almost half of the population are overweight. Hence emergency doctors are increasingly confronted with obese patients for whom special anatomical and physiological factors need to be considered. Furthermore this could lead to poorer quality and delayed treatment as normally available emergency therapy and transport are not designed for the special needs of patients with extreme obesity. The following article describes the special factors in the emergency treatment of these patients.

Background: Beneficial effects of intravenous tissue Plasminogen Activator (tPA) in acute ischemic stroke (AIS) are strongly time-dependent. In PHANTOM-S, we use a specialized stroke ambulance equipped with a CT-scanner and point-of-care laboratory in order to shorten time-to-treatment. We report feasibility and safety of the 3-months pilot phase. Methods: The ambulance (staffed by a neurologist, paramedic and technician) is deployed by the dispatch center when the emergency call algorithm yields a suspected acute stroke. The pilot study was restricted to patients able to give informed consent. Preliminary Results: Between February 8 and April 30, 2011, the ambulance was deployed 208 times. Specific medical management was provided for 108 patients. 54 patients (50%) had a stroke while 31 (29%) had other neurological and 23 (21%) non-neurological diseases. 24 (48%) (median-NIHSS: 8; mean-age: 75±12) of 50 patients with AIS ambulance diagnosis received tPA (23 in the pre-hospital setting and one patient after admission for CT dysfunction). One of the tPA treated patients had a final non-stroke diagnosis (sepsis). Mean alarm-to-treatment time of pre-hospital tPA application was 58 minutes (62 minutes including the in-hospital tPA-application) compared to 98 minutes in 50 consecutive patients treated with tPA in Charité hospitals in 2010. Two (8%) of the tPA patients suffered a symptomatic intracranial hemorrhage and one patient (4%) died in-hospital. Technical failures comprised one CT dysfunction and two delayed CT-image transmissions Conclusions: Pre-hospital acute stroke management including tPA-application is feasible and the results suggest a significant shortening of time-to-treatment without obvious safety concerns. Final data will be presented at the ISC.