title: Higher prehospital priority level of stroke improves thrombolysis frequency and time to stroke unit: the Hyper Acute STroke Alarm (HASTA) study.
abstract: OBJECTIVE
  Early initiated treatment of stroke increases the chances of a good recovery. This randomized controlled study evaluates how an increased priority level for patients with stroke, from level 2 to 1, from the Emergency Medical Communication Center influences thrombolysis frequency, time to stroke unit, and whether other medical emergencies reported negative consequences.
  
  
  METHODS
  Patients aged 18 to 85 years in Stockholm, Sweden, with symptoms of stroke within 6 hours were randomized from the Emergency Medical Communication Center or emergency medical services to an intervention group, priority level 1, immediate call of an ambulance, or to a control group with standard priority level, that is, priority level 2 (within 30 minutes). Before study start, an educational program on identification of stroke and importance of early initiated treatment was directed to all medical dispatchers and ambulance and emergency department personnel.
  
  
  RESULTS
  During 2008, 942 patients were randomized of which 53% (n=496) had a final stroke/transient ischemic attack diagnosis. Patients in the Emergency Medical Communication Center randomized intervention group reached the stroke unit 26 minutes earlier than the control group (P<0.001) after the emergency call. Thrombolysis was given to 24% of the patients in the intervention group compared with 10% of the control subjects (P<0.001). The higher priority level showed no negative effect on other critical ill patients requiring priority level 1 prehospital attention.
  
  
  CONCLUSIONS
  This randomized study shows negligible harm to other medical emergencies, a significant increase in thrombolysis frequency, and a shorter time to the stroke unit for patients with stroke upgraded to priority level 1 from the Emergency Medical Communication Center and through the acute chain of stroke care.
authors.affiliation: Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, 118 83 Stockholm, Sweden.
authors.forename: Annika
authors.initials: A
authors.lastname: Berglund
authors.forename: Leif
authors.initials: L
authors.lastname: Svensson
authors.forename: Christina
authors.initials: C
authors.lastname: Sjöstrand
authors.forename: Magnus
authors.initials: M
authors.lastname: von Arbin
authors.forename: Mia
authors.initials: M
authors.lastname: von Euler
authors.forename: Nils
authors.initials: N
authors.lastname: Wahlgren
authors.forename: Lars
authors.initials: L
authors.lastname: Engerström
authors.forename: Bo
authors.initials: B
authors.lastname: Höjeberg
authors.forename: Tor-Björn
authors.initials: TB
authors.lastname: Käll
authors.forename: Susanna
authors.initials: S
authors.lastname: Mjörnheim
authors.forename: Ann
authors.initials: A
authors.lastname: Engqvist
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006282:Health Personnel / Q000193:education; D006757:Hospital Units / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy*; D013548:Sweden; D015912:Thrombolytic Therapy; D013997:Time Factors; D014187:Transportation of Patients / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014218:Triage / Q000379:methods*
chemical_list: D005343:Fibrinolytic Agents