Saudi Stroke Standards

Early Detection Purpose To ensure that signs and symptoms of stroke are recognized by the public and healthcare professionals to facilitate rapid detection of stroke and enable quick initiation of treatment in an appropriate setting. Rationale  Fast response to stroke reduces the risk of death and disability.  Both public and professional awareness of stroke are crucial for patients to receive appropriate care. Standards 1. Public and professional (including physicians, healthcare facilities personnel, and EMS personnel) stroke education campaigns should be regular and frequent to increase awareness of stroke and the need for urgent diagnosis and treatment. 2. Networks should ensure that people who have had a stroke, and their families and care givers, are informed and empowered, by providing information, advice and support and ensuring that services are in place to support people. 3. All healthcare professionals should be trained to recognize signs and symptoms of stroke indicating an acute stroke as an emergency, requiring immediate transfer to a stroke unit. 4. Patients seen by community-based healthcare professionals with the sudden onset of focal neurological deficit should be screened for hypoglycemia with a capillary blood glucose and for stroke or TIA using a validated tool such as FAST, as soon as possible. 5. Patients with an acute focal neurological deficit suspected to be a stroke should be moved directly to an appropriate stroke hospital. 6. EMS should be activated as soon as possible to ensure that patients with a positive stroke screen and/or a strong suspicion of stroke are transported rapidly to the closest stroke care unit that can administer IV Alteplase. 7. Standardized written protocol and standing orders for the emergency evaluation of patients with suspected stroke is recommended. 8. Telemedicine services can be used appropriately where necessary to ensure urgent management. 9. Patients who have had a suspected TIA should be assessed as soon as possible for their risk of subsequent stroke using a validated scoring system such as ABCD2. Chapter 4. Integrated stroke care Objectives  To improve speed, accuracy and consistency of stroke assessment and treatment for all patients.  To improve the speed of patient transfer to an appropriate stroke facility so that patients can receive rapid diagnosis and treatment.  To treat people with suspected stroke as a medical emergency in order to provide optimal treatment and maximize the chances of independent living after stroke.  To assess people experiencing a transient ischemic attack (TIA) or minor stroke rapidly in order to minimize the chances of a full stroke occurring.  To ensure that all the patients that can benefit from reperfusion therapy are identified as soon as possible and appropriate therapy is administered in an evidence-based manner. Key facts  There is a 20 per cent risk of a full stroke within the first four weeks after a TIA.6  Approximately 69% of the strokes are ischemic strokes and IV r-tPA rates are 0.5%.  Stroke is a common emergency seen in the Kingdom of Saudi Arabia.  Most stroke patients are transferred by private mode such as private car.  EMS transferred around 20% of stroke patients between 2017-2018. Introduction A more urgent response to both stroke and TIA will save lives and reduce long-term disability. Intensive physiological and neurological monitoring in the early phase of a stroke supports early treatment that stops or slows stroke progression and prevents more brain cells being damaged. Investigating and treating high-risk patients with TIA within 24 hours could produce a significant reduction in the number of people who go on to have a full stroke.7 A. Components of acute stroke care QM