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Stroke is a medical emergency, a "brain attack," and it requires the same immediate care that a heart attack receives. A rapid response to stroke requires involvement of the entire society. Despite recent overall advances in stroke care, management of stroke usually remains most effective in centers containing a unit devoted to stroke.1 A recent meta-analysis revealed that patients treated in stroke wards, units, or centers specializing in the care of stroke had a lower case fatality and a better outcome.2 This is important because stroke not only is the number three killer in the world but also causes more disability than any other somatic disease.
Stroke awareness is still poor, and the entire approach to management needs to be reorganized. A large public and professional education program is needed, similar to that which occurred when therapies for acute MI became available.
There is now evidence that managing stroke as an emergency improves outcomes and reduces costs, and many guidelines now exist to help clinicians and other health care professionals implement effective approaches. The WHO/European Stroke Council Helsingborg Declaration on Stroke management,3 the AHA guidelines,4 Guidelines of the European Ad Hoc Consensus Group,5 and the new AHA guidelines for the use of thrombolytic drugs6 all aim at improved stroke management.
The need for protocols. Guidelines for optimal management of acute stroke are available.3-6 They are worthless if they are not implemented in routine stroke care. This can be achieved by stroke management protocols, standing orders, and guidelines.
Prehospital care. A system of triage, analogous to care for acute MI in which the patient contacts the emergency services first, is also needed in acute stroke care to prevent unnecessary delays. If a patient first contacts a family doctor, this often leads to a delay …
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