The system of Emergency medical services was created to provide help to everyone who is in sudden threat to human health. The legislator precisely specifies the definition of sudden thread to human health as sudden or foreseeable occurrence of symptoms compromising the health status with possible serious injury of body functions or bodily injury, or, loss of human life as a direct consequence, requiring immediate medical rescue activities. The Act on the State Medical Rescue Services provides minimising the time that has elapsed from the occurrence of the sudden thread to human life to entering medical treatment at a specialist department (1).

Each year stroke is diagnosed at approximately 15 million people worldwide. From 4.6 to 5.7 million people die from brain stroke which constitutes 10% of overall deaths globally (2-4).

In developed countries brain stroke is the third leading cause of death, and the most common cause of the occurrence of disability in people aged over 40 (2, 5). Data collected by the World Health Organization (WHO) suggest that in 2015 brain stroke was the second cause of death of adults globally after the ischemic heart disease (6).

In Europe, Poland is second after the Russian Federation with the highest rate of deaths caused by strokes. The percentage level of deaths caused by strokes in Poland is two times higher than in Germany, France or Great Britain (7, 8).

Long-term consequences of brain stroke, that is, the necessity to provide the patient care of other people and rehabilitation cause generating the highest medical treatment costs of the commonly occurring disease entities. This is the reason why brain stroke causes a serious global economic problem (9).

In 2013 the American Heart Association and American Stroke Association updated the current definition of brain stroke. Brain stroke is defined as sudden occurrence of focal or generalised disorders of the brain function caused only by vascular causes related to the brain blood flow, lasting longer than 24 hours.

Stroke may also be recognized when:

– focal neurological symptoms last less than 24 hours, however, ischaemic focus was clearly documented using brain imaging techniques,

– the symptoms resolved after thrombolytic treatment, or the patient died within the first day from the onset of occurrence of the symptoms.

If the focal neurological symptoms resolve spontaneously before 24 hours pass and the ischemic focus is not observed any more in the brain imaging examination a transient ischemic brain attack is observed (TIA) (10, 11).

In the process of increasing of the stroke outbreak 2 millions of neurons are destroyed every minute (12). An example of results of computer tomography examination of a patient with ischemic brain stroke in the first and third day of hospitalization has been presented on figures 1 and 2. The pathogenic basis of a brain stroke are brain circulation disorders growing in time (in thromboembolic, embolic or hemodynamic mechanism) which cause gradual decline of perfusion in the brain and starting anaerobic glycolysis. The free radicals formed in this process cause damage of the blood-brain barrier and influx of plasma components to the extracellular compartment, which results in increasing of the volume of the brain, as a result of angiogenic and cytotoxic edema. The clinical symptoms of perfusion and biochemical disturbances and of the increase in brain volume, depending on the vascular eel affected by the attack are neurological loses (most often quantitative and qualitative disturbances of the state of consciousness, speech impairment, mobility deficits in the scope of cranial nerves and limbs). The basis for implementing treatment of ischemic brain stroke is firstly proper recognition based on excluding other metabolic disorders that may demonstrate similar clinical symptoms (e.g. hypoglycaemia, epileptic seizure, migraine) and exclusion of haemorrhagic stroke. A routine medical imaging conducted to this end is a computer tomography examination which ensures visibility of ischemic stroke characteristics: hypodense area covered with the stroke, blurring of the borders of the insula on the side of the stroke, increased electron density in the reach of the artery covered with the stroke and the head of the caudate nucleus on the side of the stroke, and the examination allows for excluding other pathology manifested by similar neurological symptoms (hematoma, brain tumour) (13).

The key role in the treatment of ischemic stroke is played by the proceeding based on the possibility of recanalization of a closed vessel and reperfusion of areas covered with the ischemia as well as by the time that has elapsed from occurrence of the clinical symptoms till the moment of implementing the purposeful form of treatment.

Confirmation of the stroke is a basis for the application of intravenous thrombolysis with the use of the recombinant tissue plasminogen activator (rt-PA), if the time that has elapsed from occurrence of the symptoms of brain stroke shall not be longer than 4.5 hour, and, if the patient fulfils other criteria for application of this form of treatment (age 18-80, exclusion of haemorrhagic stroke, time of occurrence of symptoms at least 30 minutes and no substantial improvement after treatment). The form of the supply of rt-PA has influence on the possibility to prolong the time of recanalization of the closed vessel. In the event of intravascular interventions implemented by centres specialising in interventional neuroradiology the possibility of rt-PA supply directly to the artery affected by the thrombus through arteriography allows to prolong the time to 6 hours from the onset of occurrence of brain stroke symptoms. Results may be even more effective through mechanical thrombectomy (14-18).

In some cases when stroke symptoms are accompanied by large mass effect and the deteriorating neurological status of the patient the remaining solution is performing bone-meningeal decompression (19, 20).

The chain of survival used in emergency medicine (fig. 3) is a contractual definition of a few interdependent links that have influence on patients’ survival. The first element of the chain of survival, that is, early recognition of a patient with life thread and fast call for rescue services without any doubt have influence on minimising the effects of brain stroke (21). The subsequent links in the chain of survival in brain stroke are priority transport with previous notifying of the appropriate unit as well as fast making of the proper diagnosis and starting adequate treatment (3).

The considerations for the functioning of the Emergency Medical Services should treat patients with symptoms that may indicate brain stroke with the highest priority.

A large proportion of patients and witnesses cannot recognize the symptoms that may indicate brain stroke which causes delay in entering specialised treatment (3).

The aim of the conducted simulated action of the Medical Rescue Teams was the assessment of the performed medical rescue activities in a patient with suspected brain stroke. The teams’ activities related to the classifying of a patient for immediate treatment at a specialised stroke department were assessed. The operations were assessed according to the Guidelines of the Group of Experts of the Vascular Diseases Section of the Polish Society of Neurology from the year 2012.