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Reappraisal of stroke systems of care
  1. Rishi Gupta
  1. Correspondence to Dr Rishi Gupta, Neurosurgery, Wellstar Health System, 61 Whitcher Street, Suite 3110, Marietta, GA 30060, USA; Rishi.gupta{at}

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Cities and communities around the world are working towards realigning their stroke pathways to identify patients with larger stroke syndromes who may benefit from mechanical thrombectomy. This daunting task will undoubtedly continue to be refined rapidly over the next decade as there will be a further intersection of technology and science. Moreover, each community will have a different process given the local politics, provider pool, and geography. Attempts are being made to simplify a rather complex decision tree in order to identify a group of patients with the most devastating strokes.

It is estimated that there are nearly 840 000 credential emergency medical service (EMS) providers in the USA (excluding first responders), with the majority being trained at the basic level and far fewer at the intermediate level.1 Interestingly, a large proportion of providers are volunteers with an average career of 5 years and rank near the bottom of wage earners in the USA. …

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.