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Cell Biology JoVE (Open Access) Citable · DOI

Prehospital Thrombolysis: A Manual from Berlin

DOI: 10.3791/50534-v
What you'll learn
  • ✓ Identify stroke presentation and initiate prehospital CT imaging for rapid diagnosis
  • ✓ Perform preliminary examination, blood sampling, and INR assessment in ambulance
  • ✓ Administer intravenous thrombolysis (tPA/alteplase) within critical time window
  • ✓ Minimize door-to-needle time through coordinated dispatch and transport protocols
Protocol

Biopharma Insights Identification of suspected stroke in the dispatch center of the Berlin Fire Brigade prompts the deployment of a CT-equipped ambulance. If ischemic stroke is confirmed and contraindications are excluded prehospital thrombolysis is applied.

Difficulty
advanced
Total time
~45 min door-to-treatment; variable based on patient location and hospital distance

Steps

1
Recognize stroke emergency and deploy CT-equipped ambulance

Dispatch center identifies suspected acute stroke presentation and sends mobile CT unit. This initial triage step determines whether advanced prehospital intervention is warranted.

▶ 01:12
2
Perform preliminary examination and collect blood samples

Paramedics conduct rapid neurological assessment, obtain venous blood samples, and measure International Normalized Ratio (INR) to assess bleeding risk before thrombolysis.

▶ 01:33
3
Confirm ischemic stroke with CT and exclude contraindications

On-board CT imaging differentiates ischemic from hemorrhagic stroke and identifies contraindications to thrombolysis. Clinical decision-making determines treatment eligibility.

▶ 02:21
4
Administer intravenous recombinant tissue plasminogen activator

Paramedics establish IV access and inject tPA (alteplase) at appropriate dosing while patient is still in transit or upon arrival, maximizing therapeutic window.

▶ 03:39
5
Transport patient to comprehensive stroke center

Continue prehospital care and expedited transfer to hospital for monitoring and potential additional interventions (thrombectomy, imaging follow-up).

▶ 04:15
6
Document alarm-to-needle time and clinical outcomes

Record total time from dispatch to thrombolysis administration to assess protocol efficacy and identify optimization opportunities for future stroke responses.

▶ 04:46
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