Prehospital stroke treatment in German-speaking countries Survey of medical directors of emergency medical services in Germany, Austria, and Switzerland

Background: The prognosis of stroke patients can be improved by adherence to clinical guidelines.ObjectiveTo analyse the current state of organisation of prehospital stroke treatment in Germany, Austria and Switzerland with a focus on guideline adherence.Materials and methods: All medical directors of emergency medical services (MDEMS) in Germany (n = 178), Austria (n = 9) and Switzerland (n = 32) were invited to complete an anonymous online survey (unipark.com, Tivian XI GmbH, Cologne, Germany) which was available for 10 weeks from April-June 2020. Participants were asked for information regarding structural organisation, clinical treatment and strategic/tactical aspects.Results: The survey was completed 69 times and 65 datasets were analysed (4 participants without MDEMS status): 73.8% (n = 48) were MDEMS from Germany, 15.4% (n = 10) from Switzerland and 10.8% from Austria (n = 7). The survey results show relevant differences in the infrastructure of and the approach to prehospital stroke treatment. Standard operating procedures for stroke treatment were in place in 93.3% (n = 61) of the EMS areas. Furthermore, 37% (n = 24) of the EMS areas differentiated between stroke with mild and severe symptoms and 15.4% (n = 10) used specific scores for the prehospital prediction of large vessel occlusion strokes (LVOS).Conclusions: Our data highlight the heterogeneity of prehospital stroke treatment in Germany, Austria and Switzerland. Consistent use of appropriate scores for LVOS prediction and a higher adherence to recent clinical guideline in general are measures that should be taken to optimise the prehospital treatment of stroke patients.