When EMS could make a difference but doesn't.

Prenotification as important as EMS treatment

Early hospital notification from EMS could speed the care of stroke patients, yet in one third of stroke situations, there was no prenotification. Those are the findings from 2 published studies looking at the treatment of acute ischemic stroke patients.

Alerting the hospital of ischemic stroke patients allows for appropriate teams to be assembled and speeds evaluation, imaging and treatment such as tPA.

Early prenotification in these situations is based on recognition of the problem. The EMS provider has to be able to identify even the subtle indications of an ischemic stroke event. Abnormal findings in mental status, cranial nerve exam, and motor function are warnings signs of stroke that should be transmitted to the receiving facility as soon as possible.

Although patient history is vital in these situations, remaining on scene for a prolonged period of time to obtain a history or detailed exam may not benefit the patient. Keep it simple and focus on:

• patient info: when was the patient last seen as normal by family/caregiver?
• obtain vital signs including blood glucose. 
• history points: any history of trauma? Of headache?

Continual assessment is required as symptoms may evolve after the initial exam is conducted. Its estimated that 80% of strokes are ischemic - resulting from an occluded cerebral artery as a result of thromboembolism. Clot formation can come from the heart or another blood vessel.

The goal of any EMS system should be to identify and prioritize patient needs, treating accordingly. Early prenotification to the appropriate receiving facility has to fit into this line of treatment. The question then becomes one of identifying why prenotification is not taking place as often as it should. Are signs and symptoms of stroke not being recognized in one-third of stroke patients? I find that hard to believe. Or, is technology the problem. The modes of communication between ambulance crews and hospital workers varies from location to location. Perhaps one way of correcting this situation is to improve the means of communication and information delivery.