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Updated Protocol for Stroke Code Management in Prehospital Settings: The Iranian Comprehensive Stroke Code Management

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Area of Science:

  • Neurology
  • Emergency Medicine
  • Public Health

Background:

  • Prehospital stroke care protocols are crucial for timely interventions.
  • Existing protocols face challenges like increased scene time and delays.
  • Updating the Iranian national code stroke protocol is necessary to improve care quality.

Purpose of the Study:

  • To update the Iranian national code stroke protocol for prehospital settings.
  • To address barriers and improve the efficiency of stroke care delivery.
  • To integrate evidence-based practices into prehospital stroke management.

Main Methods:

  • A mixed-methods approach was used in the second phase of the Iranian Comprehensive Stroke Code Management Program.
  • The Caspian scientific 10-step method, including literature review, expert consensus (Delphi, RAND), and stakeholder input, was employed.
  • The updated protocol was structured into three stages: on-scene, ambulance care, and on admission.

Main Results:

  • The updated protocol emphasizes rapid assessment using ABCs and BEFAST criteria, with an on-scene time target of under 5 minutes.
  • Ambulance care includes SAMPLER history, maintaining oxygen saturation, ECG, and coordination by a Master of Science in Nursing (MSN).
  • In-hospital admission focuses on precise handover, 24/7 pager alerts, stroke code clocks, CT-ready teams, and continuous protocol refinement.

Conclusions:

  • Key updates include implementing stroke clocks, 24/7 pager alerts, direct computed tomography (CT) scans, BEFAST assessment, and reduced scene times.
  • Centers are recommended to enhance infrastructure and resources for successful protocol implementation.
  • Future phases will focus on the implementation and evaluation of the updated protocol.