STROKESTEMO/ MSU a German Approach

SYMPTOMS

Depend on the effected brain area Paralysis of Contralateral Arm/Leg and Face

(Hemiplagia) or weakness (Hemiparesis) Aphasia (if in dominant hemisphere)/ Alexia Numbness in Limbs Altered smell, hearing or vision

2 Types: Thrombosis (Obstruction) or Hemorrhage

Acute Ischemic Stroke 70-80%

Intracerebral Bleeding 20-30%

Statistics:

270 000 cases a year (83mio citizen) 20% fatal

3rd most common fatal disease 70-80% Ischemic Stroke – 20-30% ICB

Treatment:

-Thrombectomy

-Hemicraniectomy

-Trombolysis-via t-PA tissue plasminogen activator (only effective therapy considering time and infrastructure)

Time dependent (possible till max 4-4.5h) Notice – Call – Arrival-transport-Hospitalisation-

diagnosis-treatment TIME IS BRAIN! → MSU

Stationary emergency transport

required Localized in Emergency

Deparment (Clinic) Time limit for

Thrombolysis often passed (4.5 h)

(52%)

Mobile Stroke Unit/STEMO

Diagnosis on scene Thrombolysis on scene Chain shortened to: Notice-call-> no further

time loss

The MSU/STEMO Truck based “Mobile intensice care unit” Type C

(12t) -EN1789/En1865

+ mobile BGA + POC Lab + mobile C-CT +equipment for induced hyperthermia (neuroprotection)

allows preclinical Thrombolysis Crew: -1x Paramedic -1x Emergency Physician -1x Radiographer

New approach for emergency treatment in Germany Model study started 2008 (Saar), 2011 (Berlin)

Results show: Improvement dependent on location In Regions with higher frequent Neurology

departments / Stroke-Units no MSU required In low frequent areas recommendable (MSU)

Sources:

Emergency Neurology- L.Roos-Springer 2012 Basiswissen Neurologie- P. Berlit- Springer 2007 Acute Ischemic Stroke- Gonzales- Springer 2011 German State Institute of Statistics -

http://www.gbe-bund.de/gbe10/abrechnung.prc_abr_test_logon?

p_uid=gastg&p_aid=&p_knoten=FID&p_sprache=D&p_suchstring=10404::Schlaganfall

Firedepartment Berlin http://www.gbe-bund.de/gbe10/abrechnung.prc_abr_test_logon?

p_uid=gastg&p_aid=&p_knoten=FID&p_sprache=D&p_suchstring=10404::Schlaganfall