1. Medical Technology and its role in Establishing Stroke Care Services Globally: World Stroke Organization and WHO Perspective
Dr Jeyaraj D Pandian MD DM FRACP FRCP FESO
Vice-President, World Stroke Organization
Principal/Dean, Professor of Neurology,
Christian Medical College, Ludhiana, Punjab India

2. Disclosure
Received Research Grants from Indian Council of Medical Research; Department of Biotechnology; National Health and Medical Research Council, Australia; National Institute of Health Research, United Kingdom

3. Stroke Stroke is the major cause of death and disability globally
Stroke care services are not well developed in Low- and middle-income countries (LMICs)
World Stroke Organization (WSO) had published a road map and action plan for stroke care services across all levels of health care (minimal, essential and advanced)
The objectives were to merge the WSO action plan with World Health Organization (WHO) stroke intervention list

4. Search Strategy All published latest Stroke Guidelines
High Income and Low and Middle Income countries
Evidence based medical technologies
Minimal (Primary care), Essential (Secondary care), Advanced (Tertiary)

5. WSO Roadmap and Action Plan
Lindsay et al. Int J Stroke Oct;9 Suppl A100:4-13.

6. Minimal/Primary Health Care Level
Public awareness: Charts, educational materials, Videos etc
Emergency alert system: Facilities to call ambulance services
Acute care: FAST training

7. Minimal/Primary Health Care Level
BP apparatus, Glucometer, 12 lead ECG machine
Referral to Secondary/Essential care services
Prevention: Screening for risk factors: Mobile app: Stroke Riskometer
Monitoring of BP, Sugar etc by mHealth algorithms

8. Minimal/Primary Health Care Level
Essential medicines
Antiplatelets (Aspirin), Antihypertensives (Ramipril, Amlodipine), Antidiabetics (Metformin), Lipid lowering drug (Atorvastatin)

9. Essential/Secondary Health Care Level
Public awareness: Charts, educational materials, videos
Emergency alert: Availability of ambulance
Emergency department protocols
Imaging: CT Scan machine

10. Essential/Secondary Health Care Level
Stroke unit treatment protocols (Swallow assessment, FESS protocol, DVT prophylaxis, depression screening)
Cardiac monitors
12 Lead ECG machine
Carotid Ultrasound
Echocardiogram
Facilities to do Complete blood count, Lipid profile, Blood sugar, Renal functions, Coagulation parameters (PT/PTTK/INR)
Lumbar puncture if there is a suspicion of neuroinfections

11. Essential/Secondary Health Care Level
Essential Medicines
Antiplatelet drugs, Antihypertensives, Antidiabetic drugs, Lipid lowering drugs, Parenteral antihypertensives (Labetolol, Glyceryl Trinitrate)
Thrombolytic agent: recombinant Tissue Plasminogen Activator

12. Advanced/Tertiary Level Care
Technology
Emergency department protocols
CT/CTA, MRI/MRA
DSA Lab
Echocardiogram, Transesophageal Echo
Carotid Doppler ultrasound
Transcranial Doppler

13. Advanced/Tertiary Level Care
Lab facilities
Lumbar puncture: suspected cases of neuroinfections (molecular techniques)
Stroke unit: Cardiac monitoring, stroke unit protocols (FESS, Dysphagia screening, DVT prophylaxis)
Facilities for Telestroke
Rehabilitation center

14. Advanced/Tertiary Level Care
Essential medicines and interventions
Antiplatelets (Asprin, Clopidogrel), Antihypertensives, Antidiabetics, Lipid lowering drug
Parenteral antihypertensives: Labetalol, Glyceryl Trinitrate, Sodium Nitroprusside, Nicardipine
Mechanical thrombectomy (Stent retrievers)

15. Advanced/Tertiary Level Care
Endovascular Aneurysm coiling
Aneurysmal clipping
Facilities for decompressive hemicraniectomy
Cardiac valve repair
Transcutaneous closure of PFO, Atrial appendage
Carotid endarterectomy/angioplasty

16. Thank You