Direct from the community
As stroke is an acute medical emergency, most people with acute stroke access services directly from the community via a 999 call. Public awareness campaigns have served to heighten understanding that stroke is an emergency and that treatments are time-dependent. Paramedics are trained to administer standardised pre-hospital clinical assessments that increase the accuracy of detection of stroke.
From primary care
For patients where the diagnosis of stroke is not immediately clear, or who present late, referral to stroke services from primary care for investigative and diagnostic purposes may occur, but the majority of people with suspected stroke are admitted directly as an emergency.
The majority of people with suspected transient ischaemic attack (TIA) are referred from primary care to TIA (neurovascular) clinics. This should be done as an emergency. Other sources of referral of people with suspected TIA include emergency departments, ophthalmology departments and paramedics.
From hospital-based settings
About 5% of stroke patients have an acute stroke while already in hospital, and they should be transferred to a stroke unit with the same urgency used for people with out of hospital stroke. Other stroke patients require repatriation from regional neuroscience centres, having undergone specialist interventions that include thrombectomy and hemicraniectomy.