EMS and Acute Stroke Care: Evidence for Policies to Reduce Delays to Definitive Treatments

摘要

abstract_textpTremendous advances have altered the management of stroke over the past two decades. In a landmark paper in 1995, intravenous tissue plasminogen activator (TPA) was shown to improve outcomes in stroke patients when compared with the standard treatment at the time. Municipalities around the country created destination plans for their EMS systems to direct stroke patients to an appropriate stroke center and therefore prevent the costly time delays associated with interfacility transports. When properly identified as a stroke by EMS, studies show that EMS prenotification to the hospital leads to faster in-hospital times and in some cases faster treatment times. With such an important role of EMS in stroke care, the importance of proper recognition by EMS became paramount. Stroke identification tools were developed to aid in stroke recognition with varying results. Some systems developed mobile stroke units to bring the emergency department to the patient to expedite TPA administration. Recently, five studies published in 2015 demonstrated the benefit of intraarterial thrombolysis (IAT) for patients with large-vessel occlusions (LVO). While primary stroke centers are able to provide TPA management, comprehensive stroke centers are the only centers capable of providing intra-arterial interventions. Should IAT become the standard of care, EMS will have a responsibility to adjust its stroke recognition systems to differentiate patients with LVOs who might benefit from intervention at a comprehensive stroke center (CSC) and appropriately bypass a primary stroke center (PSC) for a CSC to provide them the best opportunity to receive this time-sensitive therapy and prevent the significant interfacility transport delays./p/abstract_text