Grant: Travel Awards - Institute Community Support

Background: In the event of a stroke, access to early emergency care, rapid and aggressive management to restore brain perfusion, (including timely brain imaging and thrombolytic therapy) is crucial. While comprehensive clinical guidelines delineate clear benchmarks for management and prevention of stroke, achieving guideline-based practices is extremely challenging in real-world clinical settings. Engaging EMS providers in early assessment and management of patients presenting with stroke through pre-notification protocols offers an opportunity to optimize guideline-based care. Methods/Results: To explore current pre-notification practices, a narrative review was conducted using the Medline Ovid (US National Library of Medicine, National Institutes of Health; Bethesda, Maryland USA) database and an online search of Google Scholar (Google; Mountain View, California USA). Literature on the association of hospital pre-notification protocols in reducing in-hospital treatment times, including time to physician assessment, time to brain imaging, and time to tPA was identified and critically appraised. Data were captured from 2007-2017. Results: A total of nine studies investigating EMS providers pre-notification practices of suspected acute stroke by EMS providers were included in this review. Critical analysis and synthesis of the retrieved literature determined that pre-notification practices gave rise to improvements in time-sensitive stroke management. Conclusion: The evidence reviewed suggests strong support in the current literature for the implementation of pre-notification protocols in cases of suspected acute stroke to reduce door-to-treatment times and improve patient outcomes. We hope to highlight ways in which EMS pre-notification can improve stroke management by affecting the in-hospital care pathway thereby optimizing patient outcomes.