Abstract
Background: Intravenous tPA is widely accepted as an effective treatment for acute ischemic stroke (AIS), but a limited number of patients are eligible due to time constraints or contraindications. tPA also has limited effectiveness on large vessel occlusions. For patients eligible for mechanical endovascular reperfusion (MER) therapy, critical time is spent and often wasted transporting patients between facilities. By outlining clinical criteria to help determine whether a patient would be more appropriately treated at a comprehensive stroke center (CSC) as opposed to a primary stroke center (PSC), EMS can make better informed transport decisions in the field. Purpose: To provide basic clinical criteria in an easy use format to guide pre-hospital providers in making clinical decisions in the field regarding whether to transport directly to a CSC. Methods: A badge card was developed with suggested criteria for transport to a CSC. It includes clinical symptoms and additional criteria including time from symptom onset and anticoagulant use. Stroke outreach and education is done with ground and air EMS providers to describe the clinical presentation of patients who may be candidates for MER therapy. Results: EMS providers report increased knowledge of symptoms of large vessel occlusion, as well as other criteria that might make transport directly to CSC preferable. Challenges include educating diverse groups of EMS providers across the region, lack of positive randomized studies to lend evidence to support MER therapy being superior to IV tPA in AIS, and providing a message consistent with other CSCs due to variation in practice. Conclusion: Equipping pre-hospital providers with tools and education to make educated decisions regarding appropriate destination for AIS patients who might be eligible for MER therapy can reduce transport time and therefore time to treatment. It also encourages EMS to play a more active role in the treatment of stroke patients.
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