Direct transfer of severe stroke patients to designated hospitals
In stroke treatment, every second counts. Seizing the critical time for admission can reduce brain damage and the risk of long-term disability. The Hospital Authority (HA), in collaboration with the Fire Services Department (FSD), has launched the Pre-hospital Stroke Diversion Scheme (Primary Diversion Scheme). Under this scheme, ambulanceman uses standardised medical evaluations to identify patients with suspected large vessel occlusion (LVO), and transport them directly to designated hospitals for treatment. The scheme has been rolled out in the New Territories East Cluster (NTEC) and New Territories West Cluster (NTWC), and will gradually extend to other clusters.
Evaluate patients with stroke assessment scale
As early as 2021, the HA and FSD introduced a territory-wide Pre-hospital Stroke Notification mechanism. If ambulanceman identifies patients with suspected acute stroke symptoms, he immediately alerts the nearest public hospital's accident and emergency department (A&E), allowing the stroke team prepares in advance. Dr Chris Tsang, HA's Chief Manager (Integrated Clinical Services), notes that the Primary Diversion Scheme utilises a more standardised medical evaluation: "To enhance accuracy, the HA and FSD have developed a stroke assessment scale, allowing ambulanceman to score the severity of a patient's condition based on symptoms like facial drooping or arm weakness. The scale has a maximum of nine points, with higher scores indicating a greater likelihood of LVO. Patients are transported directly to designated hospitals."
Early preparation enhances treatment outcomes
The scheme was introduced in December last year in the NTEC and NTWC. Patients from Sha Tin, Tai Po, and North District suspected of having LVO are sent to Prince of Wales Hospital, while those from Tuen Mun and Yuen Long districts are sent to Tuen Mun Hospital, to receive intravenous thrombolysis treatment or intra-arterial thrombectomy according to their clinical condition. As of early February this year, 38 patients had been transported under the scheme, 23 of whom were diagnosed with acute ischemic stroke. For stroke patients in other clusters, the ambulanceman will continue to swiftly convey patients to local public hospital's A&E for treatment in accordance with the established Pre-hospital Stroke Notification mechanism.
"The scheme facilitates the early identification and notification of suspected LVO patients, activate multidisciplinary teams — including A&E, stroke, neurology, neurosurgery and radiology — to coordinate manpower and prepare facilities such as angiography and operating theatres in advance. Upon arrival, patients are able to receive immediate examination and treatment, significantly improve clinical efficiency," Dr Tsang adds.
The Primary Diversion Scheme will expand to the Hong Kong and Kowloon clusters in the next two years. Meanwhile, the HA also plans to use artificial intelligence to accelerate the identification of stroke types and severity. The HA will also leverage the acute stroke proforma within the Clinical Management System to enhance data collection, monitoring, and quality indicator tracking for continuous service improvement.
"Time is brain. Direct transfer to designated hospitals reduces delays, but most importantly, we should educate the public to recognise stroke symptoms and seek medical help immediately," says Dr Tsang.
