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Improvements in Time-Sensitive Stroke Care and Alteplase Administration: The Iranian Comprehensive Code Stroke
Shayan Alijanpour1, Fatemeh Bahramnezhad2, Ashkan Mowla3
1Department of Nursing, School of Nursing and Midwifery (S.A.), Babol University of Medical Sciences, Iran.
Stroke
|March 4, 2026
Summary
Implementing an updated stroke protocol in Iran significantly reduced emergency response times and nearly tripled the administration of intravenous alteplase, improving acute stroke management.
Area of Science:
- Emergency Medicine
- Neurology
- Public Health
Background:
- Acute stroke management in emergency medical services (EMS) faces challenges including lack of standards and coordination delays.
- Timely intervention is critical for improving patient outcomes in stroke cases.
- This study addresses the need for evidence-based standards in prehospital stroke care.
Purpose of the Study:
- To implement and evaluate an updated national stroke protocol in northern Iran.
- To assess the impact of the Iranian Comprehensive Code Stroke Management Program on EMS performance.
- To improve the timeliness and effectiveness of acute stroke treatment.
Main Methods:
- A quasi-experimental study design was employed, comparing an intervention group (Babol EMS) with a control group (Mazandaran EMS).
- The intervention involved a multi-faceted empowerment program for EMS personnel implementing the new protocol.
- Outcomes measured included prehospital time intervals, monthly intravenous alteplase counts, and administration rates before and after the intervention.
Main Results:
- The intervention group showed significant reductions in most prehospital time intervals.
- Intravenous alteplase administration rates increased from 13.94% to 39.49% in the intervention group (P<0.001).
- The control group experienced a decrease in monthly alteplase administrations, while the intervention group showed an increasing trend.
Conclusions:
- The updated stroke protocol implementation led to significant time savings and a near-tripling of alteplase administration rates.
- The program demonstrated effectiveness in improving critical aspects of prehospital stroke care.
- Further national evaluation including long-term functional outcomes is recommended to confirm the protocol's value as a model.
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