You may notice something different about the paramedics working in prehospital coordination zones 2 and 9 in Pinchincha Province. One is that they are wearing an unmistakeable air of pride. The second is the reason they’re holding their heads so high – Angels badges on their left sleeves mark them out as winners of Ecuador’s first EMS Angels Award for excellence in prehospital stroke care.
The presentation of these badges to the operational staff was a highlight of the award ceremony in Quito, says Dr Verónica Pacheco, emergency physician and specialist in the National Directorate of Mobile Health Care Services of Ecuador’s Ministry of Public Health.
“This acknowledgement is of great importance, since the work carried out by prehospital care services is not usually recognized. Having these badges awarded by the Minister of Public Health, Dr Antonio Naranjo Paz y Miño, heightened the positive impact. It was a significant and emotional moment that will motivate other teams in the country to strive towards this award.”
Dr Pacheco has had no small part in this achievement. She led the development of the first national protocol for prehospital stroke care in Latin America, formulating guidelines that are now being implemented throughout the country.
As the custodian of an agreement between the Angels Initiative and the Ministry of Public Health, Dr Pacheco plays a key role facilitating the training of healthcare professionals in the proper management of stroke, including simulations conducted in public hospitals. The result of these efforts is the expansion of both prehospital stroke care coverage and of the network of accredited stroke centers, with hospitals in Tena, Macas and Latacunga shortly due for certification along with General Hospital Enrique Garcés in Quito.
Long distances separating towns and small cities from stroke-ready hospitals place heavy demands on emergency medical transport services, making the replacement of ambulance units a priority, Dr Pacheco says. Currently, 158 advanced life support ambulances are being delivered to strategic locations to provide adequate coverage for patients needing urgent care, including for stroke.
The creation of the protocol for prehospital stroke care and its implementation in both the public and private sectors was a vital first step. The protocol was shaped by a process of meetings with operational staff and consultations with emergency physicians, Dr Pacheco says. One of their objectives was standardizing the use of scales in prehospital evaluation; in the end they opted for three scales that are adaptable to the current reality of the health system.
Another priority is the provision of in-person training, frequently by doctors who were involved in writing the guidelines. The impact of this personal approach to training is similar to that of winning awards, Dr Pacheco suggests. In both instances it encourages ambulance staff by instilling a sense of belonging, and the awareness that they are a very important part of any stroke care team.
The prehospital care teams in Zone 2 and Zone 9 began their awards journey in May 2024. In June a review of their data showed they fell short of the mark in two of the areas covered by the awards criteria. Dr Pacheco explains: “Because in Ecuador we require hospital acceptance before a patient can be transported to a hospital, our on-scene times exceeded those stipulated in the quality parameters. Our prehospital staff also weren’t recording patient medications, information which is crucial for the decision to treat stroke.”
Among measures to address these shortcomings was the implementation of Código Rojo (code red) which eliminates the need for prior acceptance by hospitals for patients with stroke. Instead, hospitals are prenotified that a stroke patient is on the way.
Improving the standard of prehospital care completes the circle of quality care for stroke patients, Dr Pacheco says. “It is important for hospital and ambulance teams to have good relationships, speak the same language and work together to optimize times and save as many lives as we can in our country.”
Medicine runs in her family. Her father and two brothers are also doctors and their mom is a nurse, so the impulse to help people is part of her DNA. But it was saving lives that drew Dr Pacheco to emergency medicine, she says.
“It is truly my passion to be there at the moment people need me, the moment someone arrives needing emergency care, and having the opportunity to provide help and save a life. Above all to be there in that moment that is so difficult for all people, and to provide care calmly.”
She loves emergency medicine, Dr Pacheco says. “I wouldn’t change my specialty for anything. It has been a very important factor in my life. It has allowed me to be there in many difficult moments for certain people, to save lives and to give someone back their family or their quality of life. That has been crucial in my life.”
Quality stroke care also saves lives, and the rollout of stroke protocol implementation across the prehospital sector gives Dr Pacheco and her team with a vast platform for doing what she loves. Pinchincha is only the starting point, she says. “We started working in this area because this is where the capital city is located and the largest concentration of people needing care. We knew that if we won this award we could use what we learnt to develop strategies for smaller prehospital teams or those that work in less densely populated areas. We know we have to adapt and modify our approach to succeed in all the regions or provinces in Ecuador, and we are achieving that.
“I think that within just a few months there will be another prehospital team standing on a stage to be recognized for the quality of their stroke care.”
You’ll be able to tell them apart by the white wing on their left sleeve.
