Centennial Collection: Prehospital Stroke Triage

Editorials emergency medical services (EMS) paramedic prehospital stroke thrombolysis triage P rehospital care extends from the time the stroke occurs until the patient arrives at the hospital emergency department (ED).The biggest segment of this time is from stroke onset to stroke recognition and either alerting of the emergency medical services (EMS) or transport to ED by some other means.A substantial effect on public health outcomes from our acute stroke therapies could be achieved by having more patients seek help within the time frame that these therapies are of benefit.To date, however, educational efforts to get more patients to call 911 immediately upon stroke onset have had only modest success. 1 In the future, technology such as wearable alerting devices for high-risk patients, direct telecommunication from home to EDs, and reducing financial and logistic barriers to obtaining help may have a positive impact.First steps: The first step once a stroke alert occurs is dispatch of the first responder by the 911 call-taker.Such "primary" dispatch has many false positives with 6 to10 dispatches for every 1 treatable patient. 2 At the same time, roughly half of true strokes are missed by primary dispatch. 3Recently, artificial intelligence voice recognition software has been developed that may increase accuracy and reduce "misses." 4 In the meantime, first responder education on stroke symptoms and signs is crucial to be sure that these missed triages are identified on scene.