2020 Volume 25 Issue 1 Pages 7-15
In Gunma Prefecture, neurosurgeons have led the development of the emergency medical care system, promoting training courses and ensuring tissue plasminogen activator (t‒PA) therapy can be carried out in thirteen different hospitals. Evidence that endovascular therapy is beneficial in large vessel occlusion (LVO) in the brain has been established, and is beginning to be implemented in Japan. The “Basic Act on Cardiovascular Disease Measures” was launched on December 14, 2018 to promote the extension of healthy life expectancy, with Gunma Prefecture’s own policies being designed to enforce the act. We evaluated the quality of paramedic activity by post‒hoc verification in cases diagnosed as stroke, which were transported by ambulance to one of the hospitals using t‒PA therapy between 2015 and 2018. In this paper, we report whether the emergent large vessel occlusion (ELVO) screen can be applied for thrombectomy. Each emergency department carried out primary verification of stroke and the description at time of onset. An integrated medical information system, developed by Gunma prefecture, was utilized from 2017 to record confirmed stroke. The results were verified by the prefecture Medical Control Council. In January 2018, the levels of confirmed strokes, onset time described rate, and strokes determined using the Gunma’s stroke judgment was 81.6%, 75.8% and, 82.5% respectively, with Gunma’s stroke judgment being 97.2% specific and possessing a positive predictive value of 50.8%. These results show that pre‒hospital screens can be introduced to judge LVO. With this in mind, training of paramedics in the ELVO screen has been adopted. Henceforth, it will be necessary to accelerate the development of the emergency medical system with regards to stroke in order to ensure conformation with the Basic Act on Cardiovascular Disease Measurements.
