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The effectiveness of thrombolysis or mechanical recanalization for acute stroke is higher, the sooner these therapies are started. Therefore, acute stroke patients need to be evaluated by qualified staff for these therapies as soon as possible. Lay persons need to identify the typical symptoms of stroke as an emergency and act accordingly by calling the emergency medical system (EMS). The EMS team reassesses the symptoms and prompts cerebral imaging. Cerebral imaging is performed ideally in hospitals with a stroke unit where subsequent (stroke) treatments occur. On the way, the emergency team will measure and stabilize vital functions and obtain further important clinical information. Telemedicine allows communicating exact time of onset and severity of symptoms, as well as comorbidities and medication of the patient to the respective hospital. Thereby, the intrahospital workload will be disencumbered and accelerated. Some EMS vehicles now carry point-of-care laboratories and may measure lab values en route (glucose and INR [International Normalized Ratio] for example). Some ambulances are not only equipped with qualified staff, telemedicine technique, and point-of-care labs but even computer tomography (CT) to perform imaging. Such mobile stroke emergency mobiles (STEMO) or mobile stroke units may perform thrombolysis prehospitally. Prehospital thrombolysis has been proven to be initiated faster and is safe. Preliminary results even suggest superiority to intrahospital thrombolysis with respect to clinical outcome. Moreover, STEMO may perform CT-angiography and assess intracranial large-vessel status. If intracranial large-vessel occlusion is present, patients will be brought directly to hospitals able to perform mechanical recanalization. Thus, secondary transports are no longer required. |
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