Introduction: Every Second Counts in a Stroke
Stroke is a sudden emergency that can devastate brain cells within minutes. In Ireland, about one in four people will experience a stroke in their lifetime, and thousands live with after-effects each year. Yet improvements in treatment mean more patients survive with less disability. A visit to Tallaght University Hospital (TUH) in Dublin reveals how a dedicated, nationwide system helps stroke patients be treated quickly and effectively, from the first recognition to rehabilitation and prevention.
Recognition: The FAST Moment
The journey begins the moment a face droops, an arm weakens, or speech becomes slurred. Additional warning signs include sudden dizziness, blurred vision, or a severe headache. Public awareness campaigns promote FAST: Face, Arm, Speech, Time. Prompt recognition leads to rapid action and better outcomes for patients.
Ambulance: The Critical First Link
When stroke is suspected, calling an ambulance is essential. Prof Rónán Collins, a leading figure in Irish stroke care, emphasizes that most patients do not reach hospital within three hours. Time-dependent treatments exist, but only if the patient gets to the right place quickly. The National Ambulance Service and Dublin Fire Brigade fast-track suspected strokes to the appropriate hospital, briefing the stroke unit before the patient arrives. The ambulance crew often stays until the patient is checked for other conditions and a decision is made about further steps.
Emergency Department: The Fast Track
On arrival, the patient enters a dedicated ED “pit stop” for stabilization. Blood tests are drawn immediately, and a quick clinical assessment rules out stroke mimics such as intoxication or hypoglycemia. Then the patient is moved straight to imaging, recognizing that speed here can save brain tissue and improve recovery prospects.
Scanner: Decisive Imaging and Speed
CT imaging quickly determines whether a bleed is present and helps distinguish ischemic from haemorrhagic stroke. If needed, an angiogram shows brain blood supply, and a CT perfusion test reveals salvageable brain tissue. Radiographers and radiologists work under intense time pressure, often with AI-assisted software highlighting areas of concern. Dr. Collins describes this imaging stage as the most crucial rung in the pathway, guiding treatment choices that can reverse disability or prevent it altogether.
Treatment: Thrombolysis and Thrombectomy
Ischemic strokes, caused by a blocked artery, may be treated with clot-busting drugs (thrombolysis) within four and a half hours. For large vessel blockages, rapid transfer to Beaumont Hospital enables a thrombectomy to physically remove the clot. As Prof Collins notes, even in a fast-paced environment, if the diagnosis is wrong, it’s better to reassess promptly. The goal is to restore blood flow while minimizing harm, and the system is designed to act decisively in real time.
Acute Stroke Unit: Specialized Care
After initial stabilization, patients are cared for in TUH’s eight-bed acute stroke unit, with an isolation bed available. Specialist nurses, physiotherapists, and dietitians provide targeted care. Research and experience show that stroke-focused units improve survival and reduce disability compared with general wards, underscoring the importance of dedicated spaces for recovery.
Rehabilitation and Early Supported Discharge: Getting Home Sooner
Rehabilitation begins early and continues after discharge. For some patients, four weekly home visits under the Early Supported Discharge (ESD) program keep therapy intensity high while freeing up beds. About 20% of survivors can return home directly with continued in-home support. For others, rehabilitation continues at dedicated facilities, with a focus on regaining function, independence, and confidence to resume daily life.
Six-Month Review and Prevention: Stopping the Cycle
Six-month follow-ups involve clinicians, physiotherapists, and speech therapists, aiming to reduce hospital readmissions due to pneumonia, falls, or fractures. Prevention remains essential, especially as Ireland’s aging population predicts more strokes. Public health messages stress blood pressure control, healthy eating, regular activity, smoking avoidance, and moderation of alcohol. While some strokes occur under 65, the majority relate to long-term risk factors that can be managed with lifestyle changes and medical care.
Hope on the Horizon: A National Improvement Story
Since the 2008 Irish Heart Foundation audit, stroke care has transformed. Clot-busting treatments and thrombectomies are now more widely used, and stroke units like the one at TUH are setting national standards. The ongoing challenge is ensuring sufficient beds and resources to deliver this specialized care to everyone in need while continuing to refine prevention and rehabilitation strategies.
Conclusion: A System Built to Save Brain and Life
The stroke pathway in Ireland—from recognition to recovery—demonstrates how coordinated, rapid action saves lives and minimizes disability. The teamwork at TUH, across ambulance services, ED, imaging, and rehabilitation, embodies a health system aligned to keep pace with a disease where every second truly matters.
