Prehospital management of acute stroke : Using the example of Saarland ambulance services

Abstract

The preclinical care strategy was changed after reevaluation of endovascular thrombectomy in the S2k guideline of the German Neurological Society (DGN). Severe strokes should be directly transferred to neurovascular centers (model "mothership"). The severity of astroke should be determined using the LAMS (Los Angeles Motor Scale) score. The general conditions of preclinical care of patients with stroke in the Saarland are presented. The key figures and statistical data of clinic assignments in the adapted care strategy are evaluated. The 2018 data from the Saarland Ambulance Services indicate that 9.1% of all preclinical emergencies are diagnosed with "transient ischemic attack (TIA)/insult/bleeding"; 97.1% of these patients were admitted to one of the 10 hospitals in Saarland with a stroke unit. Acare time at the emergency site of 20 min was observed in 78.2%, aprehospital time of 60 min in 90.1% of the missions. Preclinically, severe strokes with LAMS score ≥4 were detected in 19.2% of all stroke patients; 71.6% of these severe strokes were assigned to one of two neurovascular centers in the Saarland. With good traffic and hospital infrastructure in Saarland, severe strokes can be treated primarily in neurovascular centers. Differentiated care requirements with monitoring of key figures in medical quality management and clear agreements with the target hospitals in the implementation of acommon care strategy are essential.