title: Curitiba acute ischemic stroke protocol: a university hospital and EMS initiative in a large Brazilian city.
abstract: Few healthcare centers in Brazil perform thrombolytic therapy for acute ischemic stroke (AIS) patients.
  
  
  OBJECTIVE
  The aim of this study was to describe an interinstitutional protocol for the rapid identification and thrombolytic treatment of AIS patients at a public health hospital in a large Brazilian city.
  
  
  METHODS
  Emergency medical services (EMS) personnel evaluated 433 patients with possible stroke during a six-month period. After a standard checklist, patients with suspected AIS and symptoms onset of less than two hours were evaluated at our University Hospital (UH).
  
  
  RESULTS
  Sixty-five (15%) patients met the checklist criteria and had a symptom onset of less than two hours, but only 50 (11%) patients were evaluated at the UH. Among them, 35 (70%) patients had ischemic stroke, 10 (20%) had hemorrhagic stroke, and 5 (10%) had other diagnoses. Of the 35 ischemic stroke patients, 15 (43%) underwent IV thrombolysis.
  
  
  CONCLUSIONS
  The present study demonstrated that trained EMS workers could help to improve the rate of thrombolytic treatment in large Brazilian cities. Permanent training programs for EMS and hospital staff, with quality control and correct identification of AIS patients, should be implemented to increase appropriate thrombolytic therapy rates in Brazil.
authors.affiliation: Cerebrovascular Diseases Unit, Neurology Division, Internal Medicine Department, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba PR, Brazil. lange@ufpr.br
authors.forename: Marcos Christiano
authors.initials: MC
authors.lastname: Lange
authors.forename: Viviane Flumignan
authors.initials: VF
authors.lastname: Zétola
authors.forename: Monica F
authors.initials: MF
authors.lastname: Parolin
authors.forename: Laura N
authors.initials: LN
authors.lastname: Zamproni
authors.forename: Artur F
authors.initials: AF
authors.lastname: Fernandes
authors.forename: Elcio Juliato
authors.initials: EJ
authors.lastname: Piovesan
authors.forename: Edison Matos
authors.initials: EM
authors.lastname: Nóvak
authors.forename: Lineu César
authors.initials: LC
authors.lastname: Werneck
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D000552:Ambulances; D002985:Clinical Protocols; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006779:Hospitals, Public; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator