Transient ischaemic attack 999 emergency referral

INTERVENTION: The intervention is a complex package including paramedic training; a risk stratification checklist for assessing patients with suspected TIA; and a referral protocol and process. At the core of the intervention is the protocol to support assessment and decision‐making. In accordance with Medical Research Council (MRC) guidance, paramedics will be randomised rather than patients, since the intervention targets health professionals with the aim of studying effects on patient outcomes. CONDITION: Transient ischaemic attack (TIA) ; Circulatory System PRIMARY OUTCOME: 1. Time to subsequent emergency contact (999 call or ED attendance) or death; 2. Time to specialist assessment by a stroke consultant or TIA specialist nurse SECONDARY OUTCOME: 1. Outcome of contact: whether patient is taken to hospital or left at home and referred or left at home but not referred, together with time from onset to additional therapy; and attendance at TIA clinic (who and when); 2. Health care utilisation in one month and three months following contact; 3. Patient‐reported outcomes: satisfaction with care received (Quality of Care Monitor); health status (SF‐12) at one month and three months; 4. Costs of implementation, and costs of care and consequences per patient; 5. Appropriateness of clinical management INCLUSION CRITERIA: Patients will be eligible for the study if they are: 1. Attended by a trial paramedic during the recruitment period 2. Coded as low‐risk suspected TIA by the attending paramedic using the standard tool 3. Attended in the catchment area of the two hospitals taking part in the trial All paramedics working in within the study area are eligible