Prehospital Stroke Care Part 1: Emergency Medical Services and the Stroke Systems of Care

Abstract

Acute stroke care begins before hospital arrival, and several prehospital factors are critical in influencing overall patient care and poststroke outcomes. This topical review provides an overview of the state of the science on prehospital components of stroke systems of care and how emergency medical services systems may interact in the system to support acute stroke care. Topics include layperson recognition of stroke, prehospital transport strategies, networked stroke care, systems for data integration and real-time feedback, and inequities that exist within and among systems.

Expert opinions from the 2024 closed door round table discussion on improving stroke prehospital care globally

“…The team will collaborate with international experts to develop a series of reviews along with case studies for publication identifying the evidence and potential solutions to be addressed in stroke prehospital care, especially in LMICs. While there are recent systemic reviews about stroke prehospital care, 9,10 these mainly focused on well‐developed nations. Funding and Innovation : Stroke prehospital care is under‐developed, and underfunded 11 . The taskforce should expand its efforts to improve funding, innovation and research in this area. Sustained collaboration : An annual meeting and expert round table discussion should occur to maintain the momentum to improve stroke prehospital care by identifying issues and potential solutions across the world with a focus on LMICs.…”

Prehospital Stroke Care Part 2: On-Scene Evaluation and Management by Emergency Medical Services Practitioners

“…In Part 1 of this series, the authors describe at length the considerations of direct transport to a higher level of stroke center based on prehospital stroke severity screening. 3 Often, stroke severity screens are conceptualized and described as LVO screens. However, if the destination hospital changes based on the result of the stroke severity screen, then conceptually the diagnosis of interest should be matched with the capabilities of the receiving stroke center.…”

“…The companion article discussed the prehospital phase of stroke systems of care. 3 This article presents detailed considerations related to the prehospital evaluation and management of patients with suspected stroke.…”

Epidemiology of stroke in emergency departments: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018–2022

“…Delays in timely ED admission are associated with poor patient outcomes [17]. Therefore, an emergency medical service system that can efficiently use limited medical resources by accurately triaging patients from a prehospital setting and transferring them to appropriate institutions needs to be developed [6,10]. Stroke is an important disease entity that requires adequate treatment within an eligible therapeutic time window.…”

“…Several factors were responsible for prehospital delay, such as lack of awareness of the symptoms of stroke, not summoning emergency medical services, lack of effective interactions between prehospital transfer step and hospital management, and neighborhood socioeconomic status [4,5]. Therefore, stroke must be properly recognized from the prehospital stage, and patients must be transferred to institutions capable of providing appropriate treatment [6,7]. In Korea, Stroke Statistics in Korea 2018 [8] has been published by the Korean Stroke Society in 2018, but epidemiological studies based on the emergency room are insufficient.…”