The stroke chain: From the onset of symptoms to the emergency services

Introduction. The treatment of stroke by thrombolysis or other methods (neuroprotection, basic care, etc.) is more effective the sooner it is begun. The main reasons for patients not receiving treatment during the acute phase of their illness are slowness in reaching hospital and delay in emergency assessment once they arrive there. It is necessary to identify the factors involved in these delays so as to modify what can be improved and establish guidelines. Development. In the chain of events leading to arrival in hospital there are independent factors related to the social and health characteristics of the patients, their attitudes to illness, characteristics of the stroke itself and of the health district. Analysis of the system for response to stroke patients is extremely important before investing in measures to be applied during the acute phase. This analysis should be based on the different stages at which delays may occur. Outside the hospital, the systems to be recognized are those of the patient and his family, contact with prehospital care teams and transport to the hospital of reference. Hospital care involves making contact on arrival at the Emergency Department, and the response of the neurologist or stroke team who give the initial treatment. Conclusions. Programmes of education and improvement in the organization of the different protagonists at the various stages reduce the time lost by delay [REV NEUROL 1999; 29: 617-22].