not effective itself, they could be considered as effective in the prevention of delays in hospitals.
Referral Stroke is a medical and sometimes also surgical emergency case. Successful care for victims of acute stroke begins with the recognition of both groups, public and a health professional, that stroke is an emergency case, such as acute myocardial infarct (AMI) and trauma. Most patients with stroke do not receive adequate therapy because they do not present at the hospitals on time. Successful care for victims of acute stroke, as an emergency case, depends on 4 steps in the chain: 1) rapid recognition of symptoms and response to warning signs of stroke, 2) the immediate use of an emergency medical service system (EMS), 3) priority transport by reporting the hospital that receives the patient, 4) prompt and adequate diagnosis and treatment in the hospital. When once appeared suspicion that the symptoms are result of stroke, patients or their proxies should make contact with EMS. Ambulance transport reduces late arrival in hospital after innicial stroke (level 3). Transport with helicopter has increased role in transfer of patients with stroke between hospitals and should be activated earlier. EMS should have an electronic validated algoritm of questions to diagnose stroke during a telephone interview with the patient / proxy. The patients during the first 3 hours of the onset of stroke should be given priority in evaluation / transportation by EMS. EMS ambulance dispatchers should be able to recognize symptoms and signs of stroke and to identify and implement appropriate help for patients who need urgent care due to impared consciousness, seizures, vomiting, hemodynamic instability or other early complications or comorbidity on stroke. Tools that are often used in prehospital a stroke rates assements are either “Cincinnati Prehospital Stroke Scale” or “Los Angeles Prehospital Stroke Scale” test, and the tool used for estimation of the acute condition is “NIH Stroke Scale” test. (Tests can be viewed in the appendix). The initial evaluation of patients with stroke can be
done by the doctors in the Emegerncy Center. Specifically, doctors from the Emegerncy Center can properly establish the diagnosis of stroke in about 90% of cases. Recommendations 1
1. Patients with first stroke should be treated in the stroke units (level 1). Therefore, suspected victims of stroke should be transported without delay to the nearest medical center with available stroke unit or to the hospital that provides organized acute stroke care if the unit of stroke is not available. 2. Once as symptoms of stroke are established, patients or their proxies should present in EMS or in a similar system (level 3). 3. Patients with subaroid haemorrhage should be addressed urgently in the center with conditions for neurosurgical treatment, neuroradiological interventions and neurointensive care (level 1).