title: Prehospital care of the acute stroke patient.
abstract: Emergency medical services (EMS) is the first medical contact for most acute stroke patients, thereby playing a pivotal role in the identification and treatment of acute cerebrovascular brain injury. The benefit of thrombolysis and interventional therapies for acute ischemic stroke is highly time dependent, making rapid and effective EMS response of critical importance. In addition, the general public has suboptimal knowledge about stroke warning signs and the importance of activating the EMS system. In the past, the ability of EMS dispatchers to recognize stroke calls has been documented to be poor. Reliable stroke identification in the field enables appropriate treatment to be initiated in the field and potentially inappropriate treatment avoided; the receiving hospital to be prenotified of a stroke patient's imminent arrival, rapid transport to be initiated; and stroke patients to be diverted to stroke-capable receiving hospitals. In this article we discuss research studies and educational programs aimed at improving stroke recognition by EMS dispatchers, prehospital personnel, and emergency department (ED) physicians and how this has impacted stroke treatment. In addition public educational programs and importance of community awareness of stroke symptoms will be discussed. For example, general public's utilization of 911 system for stroke victims has been limited in the past. However, it has been repeatedly shown that utilization of the 911 system is associated with accelerated arrival times to the ED, crucial to timely treatment of stroke patients. Finally, improved stroke recognition in the field has led investigators to study in the field treatment of stroke patients with neuroprotective agents. The potential impact of this on future of stroke treatment will be discussed.
authors.affiliation: UCLA Medical Center, and the Division of Neurosurgery, Department of Neurology, Los Angeles, California 90095-7039, USA. vrajajee@mednet.ucla.edu
authors.forename: Venkatakrishna
authors.initials: V
authors.lastname: Rajajee
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Saver
mesh_terms: D004631:Emergency Medical Service Communication Systems; D004632:Emergency Medical Services; D004634:Emergency Medical Technicians; D006801:Humans; D018696:Neuroprotective Agents / Q000627:therapeutic use; D020521:Stroke / Q000175:diagnosis / Q000628:therapy*; D014187:Transportation of Patients; D014218:Triage
chemical_list: D018696:Neuroprotective Agents