Paramedic PapersTopic
Stroke & neuro research
18 recent papers on stroke & neuro in paramedic and prehospital care, newest first. Each has a plain-English summary, the study design, the main finding and caveat, and what it means for Australian practice.
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Why rural stroke care lags: system drivers
A qualitative study of 11 stakeholders in coastal eastern England found rural and coastal distance becomes inequity-producing when combined with limited mobility, complex extrication and Category 2 demand, shaping delays in stroke recognition, pre-alerting and transfer to stroke-capable care.
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Scene-to-door time and stroke thrombectomy
A single-centre Japanese cohort of 121 stroke thrombectomy patients transported directly from scene found scene-to-door time was only associated with outcome in patients with pre-stroke disability, where longer intervals were linked to lower odds of a favourable 90-day outcome (aOR 0.91; ROC cut-off 14 minutes in that subgroup).
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Decision support eases stroke triage load
In a randomised crossover simulation trial, 35 Taiwanese emergency medical technicians using a stroke triage decision-support interface showed reduced mental workload (RMSSD up 4.3 ms, heart rate down, NASA-TLX lower) versus dispatch orders alone.
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POC GFAP for brain haemorrhage in coma
A UK physician-paramedic HEMS team tested whether prehospital point-of-care GFAP and UCH-L1 blood tests could detect intracranial haemorrhage in comatose patients — GFAP performed strongly (97% sensitivity, AUC 0.94), UCH-L1 less so.
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Mobile stroke units: value depends on setup
Narrative review concludes mobile stroke units deliver thrombectomy-relevant time savings only when onboard CTA links to direct routing and receiving-centre activation — non-contrast-CT units mainly speed prenotification.
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Stroke app speeds prehospital-to-ED handover
A South Korean pilot of a mobile app that streams stroke data from ambulances to EDs found shorter onset-to-door times in 34 app-supported transports versus 129 matched standard transports.
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Stroke triage tools: cost-effective, hard to sustain
Systematic review of prehospital stroke triage tools (mobile stroke units, telemedicine, biomarkers, AI) found most reports of cost-effectiveness positive, but sustained implementation is limited by complexity, workflow fit and costs.
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Consensus on designing prehospital stroke trials
An expert consensus statement setting out operational, ethical and technological priorities for designing prehospital stroke trials in conventional EMS settings, covering consent models, randomisation, endpoints and statistical frameworks.
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Online stroke education boosts EMS-seeking
RCT in 106 high-risk residents in Huanggang, China testing a 6-week online stroke education program against usual health education — it significantly improved stroke knowledge, warning-sign awareness and EMS-seeking intent.
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Two-thirds of stroke patients delay seeking care
Meta-analysis of 27 studies and 266,336 ischaemic stroke patients across 14 countries found 67.7% experienced prehospital delay before seeking care, with stroke knowledge and symptom recognition the key modifiable drivers.
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Stroke care gaps for First Nations patients
Victorian linked-data study of 32,163 EMS-attended stroke/TIA patients found First Nations patients had more than double the age-standardised incidence of EMS attendance, were less likely to receive a paramedic stroke assessment (58.2% vs 67.3%) and less often taken to thrombectomy-capable hospitals, though adjusted mortality was similar.
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AI triage of ED CT brain scans
Retrospective validation of an AI model classifying 3,424 ED CT brain scans as urgent or not — 98.3% negative predictive value with no false negative needing urgent intervention at the index visit, putting ~64% of scans in the possibly-expedite bucket pending a prospective trial.
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IM midazolam non-inferior for prehospital seizures
Randomised double-blind non-inferiority trial testing whether IM midazolam is non-inferior to IV clonazepam for prehospital seizures — it was, with 75% treatment success for IM midazolam versus 62.5% for IV clonazepam (risk difference +12.5 percentage points; 95% CI -10.0 to +33.4).
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Prehospital magnesium before thrombolysis: no overall benefit
Secondary analysis testing whether prehospital magnesium sulfate followed by thrombolysis improves 90-day outcomes — feasible and safe but no significant overall clinical benefit, though severe stroke patients (NIHSS >15) showed better outcomes in hypothesis-generating subgroup analysis.
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Over-rapid BP drop worse after ICH
Retrospective cohort examining whether rapid systolic BP reduction ≤150 mm Hg after spontaneous intracerebral haemorrhage improved outcomes — early target achievement and overshooting <120 mm Hg were associated with worse functional outcome.
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HEMS dispatch timing matters for LVO stroke thrombectomy
The efficacy of endovascular thrombectomy (EVT) for large vessel occlusion (LVO) stroke is highly time-dependent.
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Helicopter + ground transport doubles thrombectomy access
A hybrid transportation strategy improved access to MT in a single center study.
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Overshooting BP targets worsens ICH outcomes
Retrospective cohort testing whether rapid systolic BP reduction ≤150 mm Hg after spontaneous intracerebral haemorrhage improved outcomes — early target achievement and overshooting <120 mm Hg were associated with worse functional outcome.