Background and purpose: In the rapidly aging society of Japan, improvement of the emergency medical care system for stroke is an urgent concern. In prehospital care for stroke, appropriate triage, selection of the delivery facility, and decreased transport time contribute directly to prognosis. The standard treatment for acute ischemic stroke (AIS) has changed dramatically. With the introduction of new thrombectomy devices, proper placement of comprehensive stroke centers (CSCs) should be reconsidered. Accordingly, a nationwide survey is needed to develop an efficient prehospital care system. The aim of this study was to elucidate problems in prehospital care for stroke in Japan, using a nationwide fire department (FD) questionnaire survey.
Materials and methods: We conducted a questionnaire survey of 733 FDs in Japan with the cooperation of the Japanese Society of Emergency Medicine and the Emergency Planning Office of the Fire and Disaster Management Agency. The questionnaires evaluated utilization status of the Prehospital Stroke Life Support (PSLS) protocol and prehospital stroke scale (PSS), awareness of standard treatment with new devices, information on delivery facilities and transportation, use of information and communication technology (ICT), and the retraining system for paramedics.
Results: Data obtained from 664 FDs (91%) were analyzed. The PSLS protocol and PSS were used by 47.2% and 59.6%, respectively. Surprisingly, only 35.6% of FDs had knowledge about the latest treatment for AIS, and half of the FDs did not have an opportunity to learn about treatment. The proportion of FDs with a CSC in their jurisdictions was decreased in rural areas compared with urban areas (19.2% vs. 49.8%). However, helicopter transportation and ICT were not adequately utilized even in rural areas. Only half of the FDs urged paramedics to attend a PSLS course.
Conclusion: We demonstrated problems with prehospital care for stroke in Japan using a nationwide FD questionnaire survey. Placement of CSCs, adequacy of the transportation system, and communication between physicians and paramedics should be reevaluated.