Prehospital symptomatologi, respons, tidsbruk og behandling av mulige og sikre cerebrale insulter. En retrospektiv studie av prehospital respons og behandling i Ambulansetjenesten i Oslo

Abstract

Stroke is a major cause of death and disability in our country and elsewhere in the world. It is estimated that 14.-15.000 people suffer from stroke each year in Norway, and the total direct and indirect society costs related to each stroke patient are calculated to be approximately 600.000 NOK.

Modern types of treating stroke require a modern attitude towards stroke management. The well established treatment of intravenous trombolysis together with new types of interventions have shown to be effective for ischemic stroke, which is the case in ¾ of the strokes. A requirement for success here is though that the patient should be brought within 3 hours from the symtom debut to a centre offering at least intravenous trombolysis, and most recommended also possibilities for neurosurgery intervention. Ambulance response level for patients with stroke is code red according to the guidelines in the Norwegian Index for Medical Emergencies.

Ullevaal University Hospital report that only a sparsely amount of patients in Oslo estimated for this urgent treatment are submitted to this hospital. We do not know the reasons for this mismatch. It could be that the patients or their relatives contact the Emergency Medical Service system (EMS) too late to get trombolytic treatment, the patient do not present the symptoms of stroke or that the EMS-system is not able to identify patients with symptoms of stroke. We therefore decided to explore the written records for all patients with symptoms of stroke treated by the Oslo Ambulance Service and the Ambulance Dispatch Centre during the month of September 2007.

We found 115 patients with symptoms of stroke or transient ischemic attack (TIA). Less than of half the patients were brought to hospital according to the recommended EMS-response level or to a hospital offering intravenous trombolysis, and less than one third were brought to a hospital with the recommended medical competence. Medical doctors ordered ambulance transportation according to the slowest response level, i.e. code green.

It seems to be a great potential in Oslo for bringing more stroke patients to an early trombolytic treatment, thus saving lives and years of well functioning. It is a need for further education of EMS personnell, but also other health care professionals, included medical doctors, in early identification and stroke management.