title: Standardized prehospital treatment of stroke.
abstract: BACKGROUND
  The lack of standardized pre-hospital treatment is a weak link in the care of acute stroke patients.
  
  
  METHODS
  Selective review of the literature on acute stroke, with consideration of current guidelines in Germany and other countries (DGN, ESO, AHA/ASA).
  
  
  RESULTS
  The mandatory, immediate transfer of acute stroke patients to a specialized stroke unit is supported by high-level evidence. Simple, sensitive screening tests for the diagnosis of stroke are available that can be performed in the field by trained non-physician emergency medical personnel. With regard to pre-hospital treatment, adequate scientific evidence supports cardiopulmonary stabilization, as well as oxygen supplementation if there are signs of hypoxemia. The patient's neurological findings, time of onset of symptoms, current medications, and past medical and surgical history must all be precisely and thoroughly documented. The receiving hospital must be informed of the patient's impending arrival as early as possible, particularly in cases where recanalizing procedures are still a therapeutic option. Treatment with aspirin or heparin must not be started in situ, i.e. without prior cerebral imaging.
  
  
  CONCLUSIONS
  In the pre-hospital phase of stroke care delivery, the goal of a high capture rate can best be achieved through the use of appropriate diagnostic tests with maximal sensitivity. Patients with suspected acute stroke should be given the highest priority for transfer to a specialized stroke unit. Optimal pre-hospital care requires the smoothly functioning cooperation of all professionals involved, from the triaging and nursing personnel to the paramedics, dispatchers, emergency physicians in the field, and admitting physicians in the hospital.
authors.affiliation: Klinik und Poliklinik für Neurologie Universitätsmedizin Greifswald, Ernst-Moritz-Arndt-Universität Greifswald. kessler@uni-greifswald.de
authors.forename: Christof
authors.initials: C
authors.lastname: Kessler
authors.forename: Alexander V
authors.initials: AV
authors.lastname: Khaw
authors.forename: Darius G
authors.initials: DG
authors.lastname: Nabavi
authors.forename: Jörg
authors.initials: J
authors.lastname: Glahn
authors.forename: Martin
authors.initials: M
authors.lastname: Grond
authors.forename: Otto
authors.initials: O
authors.lastname: Busse
mesh_terms: D003299:Cooperative Behavior; D003431:Cross-Cultural Comparison; D004632:Emergency Medical Services / Q000592:standards*; D005858:Germany; D006757:Hospital Units / Q000592:standards; D006801:Humans; D033183:Interdisciplinary Communication; D008403:Mass Screening / Q000592:standards; D010360:Patient Transfer / Q000592:standards; D017410:Practice Guidelines as Topic; D020521:Stroke / Q000175:diagnosis / Q000628:therapy*