Streamlining of prehospital stroke management: the golden hour.

Thrombolysis with alteplase administered within a narrow therapeutic window provides an effective therapy for acute ischaemic stroke. However, mainly because of prehospital delay, patients often arrive too late for treatment, and no more than 1-8% of patients with stroke obtain this treatment. We recommend that all links in the prehospital stroke rescue chain must be optimised so that in the future more than a small minority of patients can profit from time-sensitive acute stroke therapy. Measures for improvement include continuous public awareness campaigns, education of emergency medical service personnel, the use of standardised, validated scales for recognition of stroke symptoms and for triaging to the appropriate institution, and advance notification to the receiving hospital. In the future, use of telemedicine technologies for interaction between the emergency site and hospital, and the strategy of treatment directly at the emergency site (mobile stroke unit concept), could contribute to more efficient use of resources and reduce the time taken to instigate treatment to within 60 min--the golden hour--of the onset of the symptoms of stroke.

Fassbender K ，Balucani C ，Walter S ，Levine SR ，Haass A ，Grotta J ... -  《-》

["Time is brain". Optimizing prehospital stroke management].

Haass A ，Walter S ，Ragoschke-Schumm A ，Grunwald IQ ，Lesmeister M ，Khaw AV ，Fassbender K ... -  《-》

Translation of the 'time is brain' concept into clinical practice: focus on prehospital stroke management.

Acute stroke is one of the main causes of death and chronic disability. Thrombolysis with recombinant tissue plasminogen activator within the first hours after onset of symptoms is an effective therapeutic option for ischemic stroke. However, fewer than 2% to 7% of patients receive this treatment, primarily because most patients reach the hospital too late for the initiation of successful therapy. Several measures can reduce detrimental delay until treatment. It is of importance to use continual public awareness campaigns to reduce delays in patients' alarm of emergency medical services. Further relevant measures are repetitive education of emergency medical services teams to ensure the systematic use of scales designed for recognition of stroke symptoms and the proper triage of patients to stroke centers. A most important time-saving measure is prenotification of the receiving hospital by the emergency medical services team. In the future, treatment already at the emergency site may allow more than a small minority of patients to benefit from available treatment.

Ragoschke-Schumm A ，Walter S ，Haass A ，Balucani C ，Lesmeister M ，Nasreldein A ，Sarlon L ，Bachhuber A ，Licina T ，Grunwald IQ ，Fassbender K ... -  《-》

Effects of golden hour thrombolysis: a Prehospital Acute Neurological Treatment and Optimization of Medical Care in Stroke (PHANTOM-S) substudy.

Ebinger M ，Kunz A ，Wendt M ，Rozanski M ，Winter B ，Waldschmidt C ，Weber J ，Villringer K ，Fiebach JB ，Audebert HJ ... -  《-》

Effect of prehospital notification on acute stroke care: a multicenter study.

Hsieh MJ ，Tang SC ，Chiang WC ，Tsai LK ，Jeng JS ，Ma MH ，Taipei EMS Stroke Collaborative Group ... -  《Scandinavian Journal of Trauma Resuscitation & Emergency Medicine》