Be F.A.S.T. when it comes to stroke

The Swedish ambulance was racing down a dark road. Inside vehicle painted neon yellow, the emergency doctor was bending over Kalle Svensson¹. The doctor’s suspicion: The patient had suffered a stroke. The wife of the 64-year-old Svensson called 112 after finding her husband lying on the bathroom floor. He was unable to get up on his own and unable to grasp her helping hand. Within minutes, his arm had become numb and powerless. The Emergency Medical Services team conducted a neurological and physical exam of Kalle Svensson and provided first aid. To save valuable time, a paramedic contacted the nearest primary stroke center at one of the local hospitals. This way, they are aware of the new patient and can initiate the next steps for his arrival.

The primary stroke centers (PSC) provide early diagnosis, triage and clot-dissolving therapy if needed with intravenous thrombolysis (IVT). At the local hospital, Svensson was taken directly to radiology. His symptoms had worsened at this point. The corner of his mouth was drooping, and he could no longer communicate. The CT scanner provided diagnostic images that offered valuable information about the type of treatment the patient needed. Nearly all local hospitals in southern Sweden can perform CT imaging at all times.

"A major cerebral artery is blocked,” says the PSC emergency physician, evaluating the diagnostic images. The physicians discussed the next steps with an expert from Lund University Hospital by phone. At all times, an expert from the university hospital is on call to support his colleagues. The decision was made to perform mechanical thrombectomy. A mechanical thrombectomy can remove this blood clot from the blood vessel with a catheter, restoring blood flow. “Thrombectomy is really the standard form of care that is now given for severe ischemic stroke that is caused by a large vessel occlusion,” said Johan Wasselius, senior neurointerventionalist at Skåne University Hospital.

Meanwhile, the Emergency Medical Services team at PSC waited for Svensson to be transported immediately to Lund. Mechanical thrombectomy is performed there, and complex cases are usually transported on to Lund. Because of the long distances in the southern region, the Skåne University Hospital and the PSCs introduced this improvement to save additional valuable time. If secondary transportation was indicated in the past, it could take up to 60 minutes to acquire another ambulance to drive to Lund. The EMS team plays a fundamental role in stroke care.

Kalle Svensson was then prepared for the transport to the Comprehensive Stroke Center in Lund for a mechanical thrombectomy and further treatment. Throughout his journey, he was accompanied only by a team that has known him, his symptoms and medical history from the beginning. Every minute counts in a stroke. Thanks to rapid transport, diagnosis and treatment, it was highly likely that Kalle Svensson would experience no or only minor restrictions in his everyday life.

Get to know the experts Johan Wasselius and Teresa Ullberg from Skåne University Hospital in southern Sweden and see the full story here.