EMS Management of Acute Stroke—Out-of-Hospital Treatment andStroke System Development (Resource Document to NAEMSP Position Statement)

Abstract

The American Heart Association estimates an annual incidence of stroke in the United States at 700,000, leading to over 150,000 deaths. Of all strokes, approximately 88% are ischemic and12% are hemorrhagic. Almost half of all stroke deaths occur in the out-of-hospital environment. Within a given region, the emergency medical services (EMS) system has an important role in the management of the acute stroke patient. Decisions made by EMS personnel can affect treatment andcontribute to the immediate, short-term, andlong-term outcomes of the patient. Because the patient may require emergent treatment regardless if the stroke is ischemic or hemorrhagic, EMS personnel should manage all potential stroke patients in a time-dependent nature. Proper treatment anddisposition of the stroke patient begins in the out-of-hospital environment, continues in the emergency department, andthen extends to the inpatient admission. This article reviews the literature on the out-of-hospital treatment of stroke patients andthe role of EMS in the development of stroke systems of care.

Key words:

• stroke
• emergency medical services
• systems of care