Prehospital care of the stroke patient

Acute stroke management begins in the prehospital setting. Half of all stroke patients present to the ED by ambulance [1]. The potential benefits of any diagnostic procedure or therapeutic intervention in the emergency department (ED) relies on public awareness of stroke signs and symptoms and rapid patient action once they are recognized. The activation of emergency medical services (EMS) is vital to the initial stabilization of stroke victims in the community and subsequent transportation to appropriate receiving facilities. Since the publication of the National Institute of Neurological Disorders and Stroke (NINDS) data demonstrating the benefit of tissue plasminogen activator (t-PA) administration in select acute ischemic stroke patients [2], there is renewed interest in optimizing the prehospital component of acute stroke care. To be eligible for the thrombolytic therapy the patient must arrive at the ED within 2.5 hours of onset of suspected stroke symptoms, so that thrombolytic therapy with t-PA can be provided within the 3-hour therapeutic time window. EMS providers are crucial to meeting this fundamental eligibility criterion.