Neurology, Addiction and Psychiatry Conference

The most important role of the emergency services in the stroke prehospital management is early recognition, prompt intervention, and proper transportation to the health care center. Stroke is the leading cause of mortality and disability worldwide. The urgent and efficient prehospital care minimizes brain damage and improves the outcome by saving time for minutes and seconds. In acute stroke care, minutes matter, and every minute is associated with the loss of brain functions. EMS members are educated to recognize early signs of stroke and activate emergency response mechanisms to ensure the patient is stabilized and has access to the best practice possible during transport.

The success of prehospital stroke care lies largely in the timely recognition of stroke symptoms. Standardized tools, such as the FAST scale (Face, Arms, Speech, Time), are used by EMS providers to quickly identify whether a patient is having an apparent stroke. This quick and easy little tool allows first responders to assess the patient's drooping face, weakness in their arms, confusion in speech, and how long it has been since their symptoms began-all critical indicators for stroke. Early detection in the prehospital setting accelerates the decision-making process and assures the patient to be sent to the most responsive facility for specialized care, such as a stroke center or neurology service.

Once there is a suspicion of stroke, EMS utilizes prehospital stroke care protocols for administration of life-saving interventions even before hospital admission. Among these, oxygen may be initiated, and airway management conducted, with supportive care provided en route. Another aspect of importance is prehospital notification to the receiving hospital. This alerts the stroke team, allowing for possible immediate intervention at the time of a patient's arrival. Hospitals that are equipped with a stroke-ready team can then administer intravenous thrombolysis or initiate mechanical thrombectomy in ischemic stroke and thus help prevent delays in treatment.

One of the challenges of prehospital stroke care is rapid transport to the nearest appropriate facility while balancing stabilization needs. EMS teams are trained in differentiating between ischemic and hemorrhagic strokes, each determining a different intervention. There are some innovations that are new, the telemedicine system, which includes MSUs with on-site imaging and thrombolytic therapy in a field environment that enhances EMS capabilities in prehospital stroke care through on-site diagnosis and treatment in the field.

The collaborative efforts of EMS, hospitals, and specialized stroke centers are key to an improved outcome and decreased disability in the case of a stroke. Continuous training and protocols must be developed to maintain high standards of care and maximize outcomes from stroke patients.