EMERGENCY MEDICAL SERVICES
Prehospital Advancements in Stroke Care
SAEM PULSE | NOVEMBER-DECEMBER 2022
By Irfan Husain, MD, MPH, Elijah Robinson III, MD, and Reena Underiner, MD, on behalf of the EMS Interest Group
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Prehospital stroke care has historically been defined by two goals: early identification and rapid transport to the closest appropriate stroke center. Traditionally, emergency medical services (EMS) agencies would use a validated stroke recognition scale (e.g., CPSS, LAPSS, FAST) to help identify a stroke quickly, limiting time on scene. They would then proceed to transport the patient to the closest stroke center or acute stroke ready hospital (rural setting), while providing prenotification to the receiving hospital. The hospital would then activate the appropriate resources and personnel prior to arrival. However, over the past several years we have seen some interesting new advancements in prehospital stroke management with stroke severity scales for large vessel occlusions and EMS agencies adopting mobile stroke units (MSUs).
“Regardless of the scale utilized, early identification of large vessel occlusions in the prehospital setting can lead to better clinical outcomes, as transport to either thrombectomy-capable stroke center or comprehensive stroke center can be prioritized, and earlier door-to-balloon times can be achieved.” LVO Prediction in the Field
Thrombectomy for large vessel occlusion (LVO) has become the standard of care and data has come to support its use up to 24 hours since onset in select patients with LVO. As such, many EMS agencies are now adopting stroke severity scales for LVO to be used in conjunction with the stroke recognition scale to transport
suspected LVO strokes directly to thrombectomy-capable stroke centers (TSCs) or comprehensive stroke centers (CSC) (both offering thrombectomy). Multiple prehospital stroke severity scales have been developed (e.g., VAN, RACE, C- STAT, FAST-ED, LAMS, NIHSS), with no clear consensus amongst EMS agencies as to which