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Bevan Exemplar Cohort 8 Projects

Prehospital Emergency Stroke Care: Bringing early diagnosis and reperfusion therapy to the patient

Thomas Hirst

Emergency Medical Retrieval and Transfer Service (EMRTS)

There are an estimated 7,400 cases of stroke per year in Wales, cared for in 12 stroke units, currently costing £1 billion annually. The number of stroke survivors in Wales are predicted to increase significantly over the next 20 years, with a high social and economic burden. It is vital to prevent stroke and minimise the effect that this pathology has on the population of Wales.

Established medical management for acute ischaemic stroke includes thrombolysis within 4.5 hours and mechanical thrombectomy for large vessel occlusion within 6 hours or longer depending on clot location and imaging results. Both early thrombolysis (<70 minutes from symptom onset) and thrombectomy have shown a marked effect on reducing disability in stroke survivors, thrombectomy having a NNT of 4 patients to deliver a survivor free of disability compared to thrombolysis alone.

Despite approximately 10% of stroke patients being eligible for thrombectomy across the UK, only 54 Welsh patients received thrombectomy in 2022, with only 12 performed in Wales. Current centres performing regular thrombectomy for Welsh patients are located in Bristol and Liverpool, requiring long transfers from receiving sites. Increasing pressures on the ambulance service, emergency departments and medical teams can compound delays in early stroke treatment.


  • To define the population of Welsh patients presenting with acute ischaemic stroke within the last 5 years in terms of location, clinical journey, radiological results and relevant clinical outcomes
  • To define the ‘unmet need’ with respect to patients eligible for thrombolysis and thrombectomy within this population group
  • To collate data from ambulance and air ambulance organisations within Wales on the availability, response times and transfer times for patients over the last 5 years across Wales
  • To test and evaluate the impact of a mobile stroke treatment team on Welsh patients receiving thrombolysis and thrombectomy, by developing a computational model
  • To use the model to evaluate the optimal number and location of mobile stroke teams in Wales to maximise benefit to the population
  • To engage with and utilise an expert stakeholder group to further assess and validate the results of this model
  • To perform health economic analysis on the potential cost and savings of operating one or more dedicated mobile stroke units in Wales
  • To develop a strategic proposal for a clinical trial of a mobile stroke unit within Wales, utilising modelling data

Anticipated outcomes:

The initial aim of the project would be a detailed report evidencing the proportion of additional patients receiving early thrombolysis and thrombectomy by utilising the mobile stroke unit concept. This would be utilised to conduct an economic analysis and subsequently produce a strategic case to trial the concept clinically.

This would benefit the national stroke working group, the ambulance service, emergency departments and the population of Wales.

Beyond the year of the Bevan Exemplar programme we would work with the Welsh Ambulance Service or other partners to procure and clinically trial a mobile stroke unit, to further validate the concept and present a case to deliver the model across Wales. We would expect this work to generate a number of academic publications.

Providing early stroke diagnosis, early treatment and increased access to specialist treatment outside of Wales is at the core of this project. This has the potential to have an enormous impact on quality of life for a large number of patients, reducing health and social care costs, and reducing waste.