Alijanpour Shayan, Bahramnezhad Fatemeh, Mowla Ashkan, Shafiee Sabet Mahdi, Dehghan Nayeri Nahid
Students Scientific Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
Department of Nursing, School of Nursing & Midwifery, Babol University of Medical Sciences, Babol, Iran.
Arch Acad Emerg Med. 2025 Apr 5;13(1):e43. doi: 10.22037/aaemj.v13i1.2633. eCollection 2025.
Code stroke is a framework to reduce time and improve the quality of care in the prehospital setting. However, increased scene time, delays, and other barriers in the prehospital setting necessitate updating the current protocol. This study aimed to update the Iranian national code stroke protocol for the prehospital setting.
This study represents the results of the second phase of the Iranian Comprehensive Stroke Code Management Program, a mixed methods study. We used the Caspian scientific 10-step method to update this protocol, which included a literature review, critical appraisal, extraction of recommendations, face-content validity, the Delphi method, RAND method, expert panel, stakeholders, and publishing and printing. We divided the updated protocol into three stages (on scene, ambulance care, and on admission).
Twenty experts (55% nurses; mean age 40.7±9.1 years, experience 15.9±7.9 years) were enrolled. On-Scene focuses on rapid ABC (airway, breathing, circulation) assessment, BEFAST (balance, eyes, face, arm, speech, and time) criteria, blood glucose check, and on-scene time under 5 minutes. Ambulance Care Involving SAMPLER (Symptoms, Allergies, Medications, Past medical history, Last time the patient was seen normally, Events leading up to the emergency medical service call, and Risk factor) history-taking, maintaining oxygen saturation ≥94%, symptom/witness documentation, electrocardiography (ECG) for cardiac-stroke cases, master's degree (MSN)-led transport coordination, and neurology team alerts and in-hospital admission ensuring precise handover, 724 pager alerts, stroke code clocks, computed tomography (CT)-ready team, and protocol updates via joint committees.
The main points were the stroke clock, pager 724, direct delivery to computed tomography scan, administering BEFAST, and reducing scene time. We recommend that each center to enhance the infrastructure and resources for implementation of these updates. In the next phase, we will implement and evaluate this protocol.
卒中急救代码是一种在院前环境中减少时间并提高护理质量的框架。然而，院前环境中现场时间增加、延误及其他障碍使得有必要更新当前协议。本研究旨在更新伊朗国家院前卒中急救代码协议。
本研究呈现了伊朗综合卒中代码管理项目第二阶段的结果，这是一项混合方法研究。我们使用里海科学十步法来更新此协议，包括文献综述、批判性评价、建议提取面-内容效度、德尔菲法、兰德法、专家小组、利益相关者以及发布和印刷。我们将更新后的协议分为三个阶段（现场、救护车护理和入院时）。
招募了20名专家（55%为护士；平均年龄40.7±9.1岁，经验15.9±7.9年）。现场阶段重点在于快速ABC（气道、呼吸、循环）评估、BEFAST（平衡、眼睛、面部、手臂、言语和时间）标准、血糖检查以及现场时间在5分钟以内。救护车护理包括采用SAMPLER（症状、过敏史、用药情况、既往病史、患者最后一次正常状态的时间、导致紧急医疗服务呼叫的事件以及危险因素）问诊、维持氧饱和度≥94%、症状/目击者记录、针对心源性卒中病例进行心电图检查、由硕士学位（MSN）护士主导运输协调、神经科团队警报以及确保准确交接的院内入院、724寻呼机警报、卒中代码时钟、CT准备就绪团队以及通过联合委员会进行协议更新。
要点包括卒中时钟、724寻呼机、直接送往计算机断层扫描、执行BEFAST以及减少现场时间。我们建议每个中心加强基础设施和资源以实施这些更新。在下一阶段，我们将实施并评估此协议。
