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Pre-hospital care

Patients who have had a recent stroke (i.e.  <48 hours ago) are taken by ambulance to one of our three Hyper Acute Stroke Units (HASU). Time is of the essence with stroke, as more of the brain dies the longer a stroke continues. Clot busting drugs are suitable for some patients, but only if given within 4 hours of the onset of stroke. Research also has shown that patients do better if they are treated for the first few days in a HASU, as these centres provide specialist stroke care.

It is therefore critical that an ambulance is called for patients as soon as possible, where the onset of stroke symptoms is <48 hours ago – the FAST test can be used to help diagnosis. This pre hospital pathway training video shows you why it is so important our pre hospital clinicians assess as soon as possible. Please ensure we promote ringing 999 immediately on noticing any symptoms associated with stroke. Ensuring we recognise strokes where the FAST symptoms are also negative is very important and ongoing work to improve this continues through educational webinars.

Patients who have had a stroke >48 hours ago are treated at a District Stroke Centre (DSC) in their local hospital, as they need rehabilitation rather than emergency stroke care, and won’t benefit from going to a HASU.

Within Greater Manchester close working with the North West Ambulance Service has enabled us in recent years to develop and roll out a stroke pathway mobile phone app to ensure patients are taken to the right hospital at the first time of asking and in line with pathway stipulations. This app has now been superseded by a nationwide “NHS Service Finder” app which applies the same principles for all conditions and not just stroke.

Since October 2019 patients taking some oral anticoagulants are now transported in a more timely manner and through our local evidence this is now promoted as best practice within national ambulance guidelines.

Any further pre hospital queries can be directed by email to our Facilitator and Paramedic