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

Abstract

The prehospital phase is a critical component of delivering high-quality acute stroke care. This topical review discusses the current state of prehospital acute stroke screening and transport, as well as new and emerging advances in prehospital diagnosis and treatment of acute stroke. Topics include prehospital stroke screening, stroke severity screening, emerging technologies to aid in the identification and diagnosis of acute stroke in the prehospital setting, prenotification of receiving emergency departments, decision support for destination determination, and the capabilities and opportunities for prehospital stroke treatment in mobile stroke units. Further evidence-based guideline development and implementation of new technologies are critical for ongoing improvements in prehospital stroke care.

Stroke Systems of Care 2.0: Moving Toward Definability, Accountability, and Equity

“…Evolving evidence for EVT has also led to changes in the prehospital approach to patients with stroke, with ongoing research examining alternative prehospital stroke scales, new field-based technologies to identify large vessel occlusion, optimal triage and destination (bypass) strategies, personalized triage decision tools, and novel paradigms for EVT delivery (eg, the flying interventional team). 9 Although substantial strides have been made in improving access to EVT, many holes remain, particularly for more geographically remote and vulnerable populations.…”

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.…”

Optimizing Patient-Centered Stroke Care and Research in the Prehospital Setting

“…[31][32][33] Indeed, this has also been recognized by key stakeholders, and national efforts, for example, in the form of regional stroke destination plans, are being made to homogenize EMS education and practices in the United States and many other countries to streamline triage pathways and improve interaction of prehospital and in-hospital teams. 16,25,[34][35][36][37] In the context of a prehospital trial, 1 potential solution to ensure homogenous study conditions could be to train staff of a single EMS provider agency. However, when aiming for widespread implementation of a diagnostic tool or treatment, such an approach is not feasible.…”