8
Stroke Systems of Care
and Prehospital Management
2.4. EMS Destination Management
COR LOE
Recommendations
General Principles
1 B-NR
1. In patients with suspected acute stroke, EMS professionals
should prioritize transport to the closest appropriate facility
(acute stroke-ready hospital [ASRH], primary stroke center
[PSC], thrombectomy-capable stroke center [TSC], or
comprehensive stroke center [CSC]) to reduce time to
treatment compared with transport to a nonstroke
capable hospital.
Areas With Local Access to rombectomy-Capable Stroke Center(s)
2a B-NR
2. In patients identified by EMS professionals as having a
suspected LVO stroke, direct transport to a TSC can be
beneficial to increase EVT rates and reduce time to treatment
compared with initial transport to a non-TSC with secondary
hospital-to-hospital transfer.
Areas Without Local Access to rombectomy-Capable Stroke Center(s)
2b B-NR
3. In areas without well-coordinated stroke systems of care
(SSOC) and local hospital(s) proficient in thrombolysis
delivery and secondary interhospital transfer, it may be
reasonable for EMS professionals to consider direct transport
of suspected LVO patients to the closest appropriate TSC
(if transport will not disqualify the patient from IVT)
to increase rates of EVT and reduce time to treatment,
compared with initial transport to a local stroke center with
secondary hospital-to-hospital transfer for treatment.
3: No
benefit
B-R
4. In areas with well-coordinated SSOC and local hospital(s)
proficient in thrombolysis delivery and secondary
interhospital transfer, direct transport of patients with
suspected LVO to a distant (eg, 45–60 min) TSC compared
with transport to a local stroke center does not improve
3-month clinical outcomes.
Interhospital Transfer
1 B-NR
5. Hospitals and EMS professionals should establish agreements
and protocols to prioritize interhospital transfer of patients
with acute stroke needing a higher level of care to reduce
door-in-door-out (DIDO) times.
