Prehospital stroke care, a narrative review

Abstract

Stroke is a leading cause of disability in the United States and current treatment for stroke is limited to two modalities with well-defined time restraints. The prehospital setting is a significant and relatively easy setting for innovation in stroke care, as the most clinical decisions are made within the first several hours of symptom onset. In this review, we look at recent innovations in improving prehospital care for acute stroke including the conception of mobile stroke units, the ongoing development of stroke models for emergency providers, barriers to prehospital care, and the innovation of new telephone applications. Although there are notable improvements in acute stroke care, additional research is needed to further improve on current models and technologies.

Optimising Prehospital Pathways to Improve Acute Stroke Reperfusion Therapy Delivery: Systems-Based Approaches

“…Some reasons for this include the overcomplexity of screening tools, lack of recognition of signs and symptoms by EMS, subjective nature of certain aspects of screening tools (e.g. arm weakness), and tools containing questions that are difficult to communicate in CALD communities [1]. Training of EMS to better use these tools is a possible avenue to improve screening, as is the creation of a tool that balances ease of use with high sensitivity and specificity and that ensures high interrater reliability and ease of use for inter-linguistic communication.…”

“…Prehospital pathways are critical to acute stroke organisation. Systems-level approaches to improving the process of care or prehospital acute stroke pathways have gained attention over the last decade [1][2][3][4]. The underlying principle is based on the fact that stroke systems of care, being a timecritical medical emergency, would benefit from streamlining the process of care or pathways by reducing time delays [1].…”

“…Systems-level approaches to improving the process of care or prehospital acute stroke pathways have gained attention over the last decade [1][2][3][4]. The underlying principle is based on the fact that stroke systems of care, being a timecritical medical emergency, would benefit from streamlining the process of care or pathways by reducing time delays [1]. Recent studies aimed at improving the prehospital system are promising and demonstrate the value of such approaches [5].…”