There are about 300,000 residents living in the catchment
area of NTUH, which includes part of two cities: Taipei and
New Taipei. EMS in the catchment area of NTUH was provided
by the emergency medical technicians (EMTs) of the two
cities. Both EMS systems of two cities are mixed one-tier and
two-tier fire-based system.21 Basic life support teams are
responsible for providing EMS to most stroke patients. The
Cincinnati Prehospital Stroke Scale is used to identify stroke
patients by EMTs of the two cities. As part of the standard
protocol for patients with suspected stroke, EMTs check
blood sugar levels and query the time of symptom onset. In
NTUH, we followed the guidelines from the Taiwan Stroke
Society and the National Institute of Neurological Disorders
and Stroke criteria for patients treated within 3 hours of
stroke onset.5 For patients who were treated in the 3e4.5 h
time-window, we used the protocol of the European Cooperative
Acute Stroke Study III.6