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Acute Stroke: Current Evidence-based Recommendations for Prehospital Care
Nancy K Glober1, Karl A Sporer2, Kama Z Guluma1
1University of California San Diego, Department of Emergency Medicine, San Diego, California.
The Western Journal of Emergency Medicine
|March 15, 2016
Summary
Prehospital stroke protocols vary significantly across California EMS agencies. This study developed evidence-based recommendations to guide stroke evaluation and treatment, aiming to improve consistency in emergency medical services care.
Area of Science:
- Emergency Medicine
- Neurology
- Public Health
Background:
- Emergency medical services (EMS) protocols for suspected stroke patients exhibit considerable variation across U.S. jurisdictions.
- This heterogeneity can impact the timeliness and appropriateness of prehospital care.
Purpose of the Study:
- To develop evidence-based recommendations for prehospital stroke evaluation and treatment.
- To compare these recommendations against existing protocols of 33 California EMS agencies.
Main Methods:
- Conducted a comprehensive literature review on prehospital stroke treatment evidence.
- Augmented the review with national and international stroke guidelines to formulate recommendations.
- Analyzed California EMS agency protocols for stroke scale use, glucose evaluation, oxygen, positioning, ECG, fluid management, and regionalization.
Main Results:
- Significant variability was observed in California EMS stroke protocols.
- Most agencies utilized a stroke scale, predominantly the Cincinnati Prehospital Stroke Scale (CPSS).
- Blood glucose evaluation was universal, with action levels between 60-80 mg/dL; cardiac monitoring and ECG use varied, and over half mandated direct transport to stroke centers.
Conclusions:
- California EMS protocols for suspected stroke patients demonstrate wide-ranging inconsistencies.
- The developed evidence-based recommendations can assist EMS medical directors in standardizing prehospital stroke care protocols.
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