This document discusses prehospital stroke care. It notes that time is critical, as brain cells die every minute after a stroke occurs, increasing the risk of permanent damage. Key strategies to reduce treatment time include emergency medical service pre-notification, activating a stroke team with a single call, rapid brain imaging, and acute stroke management protocols. Guidelines for prehospital stroke systems recommend fast symptom recognition, determining the hospital destination before transport, and using telemedicine to help identify appropriate treatments and notify hospitals. The future of prehospital stroke care could see more use of technologies like tele-stroke and stroke emergency mobile units to further reduce time to treatment.

1. Prehospital
Stroke Care
dr. Ade Wijaya, SpS

2. WHO Stroke Definition
“Rapidly developing clinical signs of focal (or global)
disturbance of cerebral function, lasting more than 24
hours or leading to death, with no apparent cause
other than that of vascular origin.”

4. Risk Factors

5. Types of Stroke

6. Time is Brain
brain cells
die every
minuteincreasing the
risk of permanent
brain damage,
disability, or
death
2 million

7. Stroke and Death
30%
die
More than

8. Disability after Stroke

9. Ischemic Stroke Treatment
< 24 hours< 4.5 hours

10. Key strategies identified to meet this goal include:
• Emergency medical service pre-notification
• Activating the stroke team with a single call
• Rapid access to and interpretation of brain imaging
• Specific protocols and tools for acute stroke management
• A team-based approach
Fonarow GC, Smith EE, Saver JL, Reeves MJ, Hernandez AF, Peterson ED, et al. Improving door-to-needle times in acute ischaemic stroke. The design and rationale for the American Heart Association/American
Stroke Associations’s Target: Stroke initiative. Stroke 2011;42:2983-2989.
Door To Needle Time
Door to needle of ≤ 60
minutes in 50% of
patients with ischemic
stroke
The American Heart Association/American
Stroke Association

11. Fast Recognition of Stroke

12. Posterior vs. Anterior Infarction

13. Wen-Dan Tao. Stroke. Posterior Versus Anterior Circulation Infarction, Volume: 43, Issue: 8, Pages: 2060-2065, DOI: (10.1161/STROKEAHA.112.652420)
Posterior vs. Anterior Infarction

14. Posterior vs.
Anterior Infarction
Wen-Dan Tao. Stroke. Posterior Versus Anterior Circulation
Infarction, Volume: 43, Issue: 8, Pages: 2060-2065.

15. BEFAST vs. FAST

16. Prehospital
Stroke Care
Where Are We Now?

18. Onset to Hospital Time
Premier Jatinegara Hospital, Jakarta
January – June 2020
< 4,5 hours
> 4,5 hours
60 %
40 %

19. Prehospital
Stroke Care
What to Achieve in
the Future?

20. Tele-Stroke

21. Potentials:
- Reduce time to tPA
treatment
- Earlier start to warfarin
reversal or BP reduction
in ICH
- Identify patients suitable
for endovascular /
neurosurgical treatments
- Comprehensive
prenotification to
inhospital facilities
Limitations:
- Diagnostic accuracy may
be weakened
- High cost
Stroke Emergency Mobile Unit

22. Audebert HJ, Saver JL, Starkman S, Lees KR, Endres M. Prehospital stroke care: new prospects for treatment and clinical research. Neurology. 2013 Jul 30;81(5):501-8.
New Prospects of Prehospital Stroke Care

23. Determine Hospital Destination

24. GuidelinesGuideline: Prehospital Systems

25. Guidelines
Guideline: EMS Assessment and
Management

26. Guidelines
GuidelinesGuideline: EMS Systems

27. GuidelinesGuideline: EMS Systems

28. Take Home Messages
• Time is a key factor in stroke care; TIME IS BRAIN
• To reduce time to treatment, good prehospital care is necessary:
- Fast stroke symptoms recognition (BE-FAST)
- Emergency medical service pre-notification
- Telemedicine and stroke emergency mobile unit
• Determine hospital destination before patient transport
GuidelinesTake Home Messages

29. Thank You