Development of a Novel Stroke Patient Transport Protocol Utilizing ICT in Tokushima Prefecture

Abstract

　In the acute phase of stroke, it is imperative to initiate appropriate medical intervention without delay following the onset of symptoms.　Consequently, there exists a critical need to establish a streamlined and precise prehospital transport system to ensure the rapid conveyance of patients from the emergency scene to specialized medical institutions. 　　In recent years, the emergence of mechanical thrombectomy has markedly transformed therapeutic strategies for patients with acute ischemic stroke.　Conventional intravenous thrombolysis with tissue plasminogen activator has demonstrated limited efficacy in achieving recanalization in cases involving major cerebral artery occlusion and has yielded only modest improvements in clinical outcomes.　In contrast, mechanical thrombectomy has exhibited significant therapeutic benefit in patients with large vessel occlusion. 　　In Tokushima Prefecture, initiatives are currently underway to develop a stroke patient transport protocol aligned with the ongoing advancements in stroke treatment.　As part of these efforts, the Stroke Center, in collaboration with the Tokushima Prefectural Fire Department, implemented a prehospital stroke scale in January 2022, thereby facilitating the prompt identification and direct transfer of patients likely to require mechanical thrombectomy to the stroke center.　Furthermore, an ICT-based platform, JoinTriage, has been introduced to enhance communication between emergency medical services and the stroke center.　JoinTriage enables Emergency Medical Services personnel to efficiently assess patients using the prehospital stroke scale and instantly transmit the data to the stroke team, thus accelerating the initiation of endovascular therapy. 　　This paper presents the outcomes of these initiatives and delineates the developmental trajectory of the newly established stroke transport protocol in Tokushima Prefecture.