Abstract
On December 14, 2018, the “Basic bill on measures for stroke, heart disease and other cardiovascular diseases to extend healthy life expectancy” was promulgated. It came into effect on December 1, 2019 and an obligation to make efforts to formulate policies specific to each prefecture was imposed. In Gunma Prefecture, neurosurgeons have played a central role in developing a stroke emergency medical system. Hospitals, fire departments, and administrative trinity have been working closely together to train human resources and identify 13 hospitals that can always implement tissue plasminogen activator (t‒PA) treatment. A previous qualitative evaluation of stroke judgment in the Gunma Prefecture ambulance team revealed 82.5% sensitivity, 97.2% specificity, and 50.8% positive predictive value. In our study, we confirmed the usefulness of the large vessel occlusion screen. We introduced the domestic emergent large vessel occlusion (ELVO) screen and began training paramedics. For the purposes of this study, of the 348 patients who were suspected of having a stroke in January 2019 and were rushed to 12 of the hospitals where t‒PA can always be carried out, 122 who had been diagnosed with cerebral infarction at the hospital were targeted. We performed post‒testing at the initial stage of ELVO screen evaluation, and obtained 41.4% sensitivity, 93.5% specificity, and a false negativity rate of 16.3%. In the present report, we outline current problems and future challenges. Now that the above‒mentioned bill is in effect, it will be necessary in the future for hospitals, emergency departments, and administrative offices to continue accelerating the establishment of the emergency medical care system for stroke; this is also important as a response to the spread of COVID‒19 infection.
