Acute Stroke: Current Evidence-based Recommendations for Prehospital Care.

Nancy Glober,Joe Barger,Angelo Salvucci,Eric Rudnick,Gregory Gilbert,Kama Guluma,Kristi Koenig,John Brown,John Serra,Karl Sporer

doi:10.5811/westjem.2015.12.28995

Abstract

IntroductionIn the United States, emergency medical services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with a suspected stroke and to compare these recommendations against the current protocols used by the 33 EMS agencies in the state of California.MethodsWe performed a literature review of the current evidence in the prehospital treatment of a patient with a suspected stroke and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the stroke protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were the use of a stroke scale, blood glucose evaluation, use of supplemental oxygen, patient positioning, 12-lead electrocardiogram (ECG) and cardiac monitoring, fluid assessment and intravenous access, and stroke regionalization.ResultsProtocols across EMS agencies in California varied widely. Most used some sort of stroke scale with the majority using the Cincinnati Prehospital Stroke Scale (CPSS). All recommended the evaluation of blood glucose with the level for action ranging from 60 to 80mg/dL. Cardiac monitoring was recommended in 58% and 33% recommended an ECG. More than half required the direct transport to a primary stroke center and 88% recommended hospital notification.ConclusionProtocols for a patient with a suspected stroke vary widely across the state of California. The evidence-based recommendations that we present for the prehospital diagnosis and treatment of this condition may be useful for EMS medical directors tasked with creating and revising these protocols.

Highlights

In the United States, emergency medical services (EMS) protocols vary widely across jurisdictions
We reviewed protocols from all 33 LEMSAs within the state of California
Use of a Stroke Scale Most (85%) LEMSAs directed the use of a stroke scale (See Table 1)

Summary

Introduction

In the United States, emergency medical services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with a suspected stroke and to compare these recommendations against the current protocols used by the 33 EMS agencies in the state of California. EMS care varies widely across the U.S The Institute of Medicine report, “Emergency Medical Services at the Crossroads,” notes that EMS needs more uniform high-quality care and specific standards for evaluating that care.[2] One such standard is the prehospital protocol that EMS personnel follow while taking care of patients. We provide a summary of the evidence for the prehospital treatment of patients with suspected acute stroke and evaluate the consistency of California protocols

Methods

Results

Conclusion