Guidelines for Management of Ischaemic Stroke 2008 - ESO

ESO-Guidelines for Management of Ischaemic Stroke 2008
Referral and patient transfer
Recommendations
Immediate EMS contact and priority EMS dispatch are recommended (Class II,
Level B)
Priority transport with advance notification to the receiving hospital (outside and
inside hospital) is recommended (Class III, Level B)
It is recommended that suspected stroke victims should be transported without
delay to the nearest medical centre with a stroke unit that can provide ultra-early
treatment (Class III, Level B)
It is recommended that dispatchers and ambulance personnel be trained to
recognise stroke using simple instruments such as the Face-Arm–Speech-Test
(Class IV, GCP)
Immediate emergency room triage, clinical, laboratory and imaging evaluation,
accurate diagnosis, therapeutic decision and administration of appropriate
treatments at the receiving hospital are recommended (Class III, Level B)
It is recommended that in remote or rural areas helicopter transfer should be
considered in order to improve access to treatment (Class III, Level C)
It is recommended that in remote or rural areas telemedicine should be
considered in order to improve access to treatment (Class II, Level B)
It is recommended that patients with suspected TIA be referred without delay to a
TIA clinic or to a medical centre with a stroke unit that can provide expert
evaluation and immediate treatment (Class III, Level B)
Successful care of the acute stroke victim begins with the recognition by both the
public and health professionals [56] that stroke is an emergency, like acute
myocardial infarction or trauma. However, in practice the majority of ischaemic stroke
patients do not receive recombinant tissue plasminogen activator (rtPA) because
they do not reach the hospital soon enough [22, 36, 57, 58]. Emergency care of the
acute stroke victim depends on a four-step chain:
• rapid recognition of, and reaction to, stroke signs and TIAs
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