Pre-hospital thrombolysis of ischemic stroke in the emergency service system - A case report from the Treat-NASPP trial

Abstract

Acute stroke is a critical medical emergency and it should be tended to by early recognition and rapid triage to the correct level of care. In‐hospital, stroke is managed by neurologists and stroke‐specialists, and cerebral images are assessed by radiologists for a mutual evaluation and coherent final diagnosis of the patient. In the pre‐hospital setting, anesthesiologists trained in pre‐hospital critical care provide advanced treatment to acute trauma and medical conditions. Even when stroke is suspected, more than 50% of strokes are misclassified upon dispatch and turn out to be something else, and it is therefore mandatory that the health care provider arriving at the scene is qualified to respond to a number of conditions that are potentially life threatening. At the same time, when stroke does occur, diagnosis and appropriate treatment should be administered without delay, as the outcome is strictly time‐dependent. This represents a potential conflict, as the delay to hospital admittance and specialist treatment introduces a unfavorable time‐to‐treatment delay for stroke patients.