Table 1.

The new stroke thrombolysis model in Christchurch Hospital.

	Christchurch thrombolysis model—modified from the Helsinki Stroke model (6)
Stroke patient pre-notification	St. John Ambulance paramedic pre-notifies ED triage room with patient clinical and demographic details including national hospital index number unique to individual patient. An estimated time of arrival is given. CT radiographer, neurology resident, and stroke nurse are paged via “Code Stroke” call to switchboard
Medical history	Patient electronic medical record, including general practitioner, next of kin details, laboratory results, and a South Island wide PACS system is examined. Next of kin contacted for collateral history prior to arrival as required
Direct to CT	Upon arrival, the patient is examined on the ambulance trolley to determine eligibility for thrombolysis. If deemed, eligible patient is transported to the CT suite located on first floor of the hospital. Electronic ordering of CT is performed by stroke nurse or ED physician
Intravenous line/laboratory testing	Patients usually have 18-gauge antecubital fossa intravenous line, otherwise this is inserted on arrival in ED. Bloods drawn on arrival or on CT table. Blood results not required prior to contrast CT or thrombolysis
Point-of-care INR/administration of idarucizumab	Point-of-care INR available. Idarucizumab stored in ED fridge and taken with patient to CT suite and administered there prior to thrombolysis
tPA in CT suite	Bolus given on table, but usually in a clinical cubical adjacent to the CT scanner
Regular paramedic/resident education	Four monthly stroke model education session with rotating registrars. Annual formal paramedic education and update on stroke statistics

CT, computed tomography; ED, emergency department; INR, international normalized ratio; PACS, picture archiving and communication system; tPA, tissue plasminogen activator.