Stroke is amongst the most frequent diseases in prehospital emergency care. Although appropriate management and triage of stroke patients have a critical impact on stroke prognosis, there is still limited evidence regarding beneficial concepts in prehospital care.
Specialized stroke ambulances with CT-scanners aboard (Mobile Stroke Units) allow prehospital start of intravenous thrombolysis and have the potential to shorten time to treatment in intracranial hemorrhages. One third of tPA treatments on MSUs are started within 60 minutes (Golden Hour of stroke) while such early treatment start can only occasionally achieved within conventional care. With prehospital CT-angiography, they can also be used to select patient for endovascular treatment and pre-notification of thrombectomy teams. Registry-based comparisons suggest improved outcome by prehospital start of tPA and emphasize a tremendous effect of tPA when administered in the first 60min after stroke onset.