Best Transport Positioning For Stroke Patients

Transporting a stroke patient requires careful handling as the patient's recovery is dependent on how quickly they receive medical treatment. The best position to transport a stroke patient is a topic of ongoing research. Some studies suggest that the supine position is the best position to transport a stroke patient as it improves cerebral blood flow and cerebral perfusion pressure. However, other studies suggest that the lateral decubitus position is best as it prevents aspiration and provides the patient with a free arm for movement.

The importance of speed when transporting a stroke patient

The faster a stroke patient receives medical treatment, the higher their chances of recovery without long-term disabilities. Indeed, studies have shown that 65% of stroke patients survive without long-term disabilities when taken directly to a comprehensive stroke centre. Every minute matters when a stroke occurs, and the patient's chances of a positive recovery are improved when speed and safety come together.

The use of an emergency medical service has been shown to be associated with more rapid transport to the hospital, thus reducing the system delay between the first medical contact and final diagnosis and treatment. However, it is important to note that not all ambulance services are equal in this regard. For example, one study found that in 2.6% of cases, the transport of stroke patients to the hospital by the emergency medical service was interrupted, resulting in a delay to diagnosis and treatment.

In addition to the immediate impact on the patient's health, the speed of transport can also have consequences from a caring science perspective. For example, patients may feel disappointed and experience unpleasant feelings if their symptoms are not appropriately assessed initially, and they are left wondering if their sequelae could have been prevented or mitigated.

Therefore, it is clear that the speed of transport is of paramount importance when dealing with a stroke patient. Every minute counts, and the choice of transport method and service can significantly impact the patient's outcome and long-term quality of life.

The best mode of transport for stroke patients

Time is Crucial

Getting prompt medical attention is critical for stroke patients as it can significantly impact their long-term recovery and wellbeing. The faster a stroke patient receives treatment, the higher their chances of a successful recovery. Therefore, speed is of the essence when transporting a stroke patient, and delays should be minimised as much as possible.

Medical Arrangements and Equipment

It is essential to have the right medical equipment and personnel during transport to ensure the patient's safety and well-being. This may include ground or air ambulance services, depending on the patient's condition and the distance to the medical facility. REVA, for instance, provides air ambulance services and ensures that all the necessary conditions are met for the patient's transport.

Patient Positioning

There is no consensus on the optimal position for transporting a stroke patient. However, some studies suggest that the supine position (lying flat) may be beneficial for stroke patients as it improves cerebral blood flow and perfusion. On the other hand, sitting up can help build tolerance and provide maximum stimulation. Ultimately, the patient's position should be determined by their comfort and safety, taking into account any clinical issues such as respiratory status, secretions, or aspiration risk.

Choice of Transport Vehicle

The choice between ground and air ambulance services depends on various factors. Ground ambulances are typically used for transporting patients to the nearest stroke centre, especially in cases of full strokes. Air ambulances, on the other hand, are useful for long-distance transport and when speed is of the essence, as they can get patients to their destination faster. They are also recommended for patients who have experienced mini-strokes, as plane rides may exacerbate the underlying medical conditions.

Stroke Centre Selection

It is crucial to transport stroke patients to a facility with comprehensive stroke services and the necessary resources for treatment, such as tissue plasminogen activator (tPA) administration. The nearest facility with these capabilities should be prioritised to ensure prompt treatment.

Preparing the stroke patient for travel

When preparing a stroke patient for travel, it is important to act quickly to ensure the patient gets the help they need as soon as possible. Here are some key steps to follow:

• Call for Medical Help: Strokes are medical emergencies that require prompt treatment. Call emergency services or a medical transport service to get professional assistance.
• Monitor Vital Signs: Check the patient's vital signs, including breathing, heart rate, blood pressure, and oxygen saturation.
• Positioning: Place the patient in a comfortable and safe position. The patient should be laid flat as tolerated, unless there are clinical issues such as respiratory distress or risk of aspiration. If the patient is able to sit, ensure they are properly supported with their weight evenly distributed.
• Monitor for Aspiration Risk: Stroke patients may have sensory deficits in the laryngopharynx, which can lead to aspiration. Keep a close eye on the patient's breathing and position them on their side if there are signs of secretion problems.
• Comfort and Anxiety Management: Sudden movements and aggressive handling can cause anxiety and pain in stroke patients. Ensure that any movements are gentle and that the patient is kept comfortable and calm during transportation.
• Medical Equipment and Arrangements: Ensure that the necessary medical equipment and personnel are available for the patient's condition during transportation. This may include ground or air travel, depending on the patient's needs and the distance to the appropriate medical facility.
• Communication: Communicate clearly with the patient, explaining what is happening and providing reassurance. If the patient has speech difficulties, use alternative methods of communication, such as writing or gesture recognition.
• Documentation: Document the patient's symptoms, vital signs, and any relevant medical history. Note the time of symptom onset ("last seen normal") as this information is crucial for treatment decisions.
• Choose the Nearest Appropriate Medical Facility: Transport the patient to the nearest facility with stroke treatment capabilities, preferably a comprehensive stroke center. Notify the hospital in advance of the patient's arrival to expedite treatment.
• Minimize On-Scene Time: Keep on-scene time to a minimum, ideally no more than 15 minutes, to ensure prompt transportation to the medical facility.

The optimal position for a stroke patient during transport

Supine (Lying Flat) Position

According to some studies, the supine position can improve cerebral blood flow and cerebral perfusion pressure in stroke patients. This position is often recommended for patients with suspected stroke, especially if they are experiencing respiratory distress or have a compromised respiratory status. However, one study suggested that the sitting position might be preferable for stroke patients with specific sensory deficits in the laryngopharynx, as it can reduce the risk of aspiration.

Side-Lying Position

Laying a stroke patient on their unaffected side is often recommended to prevent further complications. This position can help promote optimal recovery by improving spatial awareness, preventing pressure sores, and enhancing autonomic nervous system function. It is also beneficial for the patient's comfort and can provide a sense of normality.

Sitting Position

The sitting position is essential for building up tolerance and providing maximum stimulation. It is recommended that a stroke patient be facilitated to sit up as soon as they are capable. However, it is important to ensure proper support for the back, arms, and legs in this position.

Considerations for Transport

When transporting a stroke patient, the primary goal is to get them to their destination as quickly and safely as possible. Speed is crucial to improving their long-term wellbeing and quality of life. It is also important to ensure the patient's comfort and avoid sudden or aggressive movements that may cause anxiety or pain.

The role of medical personnel and equipment in stroke patient transport

Medical Personnel

Medical personnel, such as paramedics, emergency medical responders, and primary care paramedics, play a vital role in the transport and care of stroke patients. They are often the first point of contact for individuals experiencing a stroke and are responsible for rapid recognition of stroke symptoms and providing initial assessment and stabilisation. This includes performing a validated acute stroke screening tool, such as the FAST (Face, Arms, Speech, Time) test, to identify potential stroke patients and determine the likelihood of large vessel occlusion. Paramedics also obtain important medical information, including symptoms, time of onset, co-morbid conditions, and current medications, which helps guide further treatment decisions.

Additionally, medical personnel provide crucial pre-hospital care, such as capillary blood glucose measurement, and coordinate with the receiving hospital to ensure a seamless transition of care. They also play a key role in educating the patient's family and providing instructions to ensure the patient's safety and well-being during transport.

Medical Equipment

Proper medical equipment is essential for the safe and effective transport of stroke patients. This includes equipment for monitoring vital signs, such as blood pressure and blood glucose levels, as well as equipment for providing respiratory support, if needed. In some cases, specialised equipment like on-site laboratories and CT scanners in mobile stroke units may be utilised to provide advanced care during transport.

The specific equipment required depends on the patient's condition and needs, and it is important to ensure that all necessary equipment is available and functioning properly before transport. This may include resuscitation equipment, intravenous (IV) fluids, airway management devices, and other tools specific to stroke care, such as thrombolytic therapy or endovascular thrombectomy equipment.

In summary, the role of medical personnel and equipment in stroke patient transport is critical to providing timely, effective, and safe care. By following protocols, utilising appropriate equipment, and coordinating with the receiving hospital, medical personnel can optimise the outcome and long-term recovery of stroke patients.

Frequently asked questions