Templates for Organizing Stroke Triage

Getting Started Physicians Hospital administration Medical Society Hospital Council Stroke survivor groups Other community groups Insurance companies AHA NSA Political sources Physician leader to guide and champion the effort Other sources of support

Physician Buy-in Stroke Team Obtaining physician participation –Appeal to their sense of duty –Demonstrations of efficacy –Utilization of ER physicians for neurological assessment –Teleradiology –Help from medical board –Financial assistance from hospital Training programs

Hospital Administration Buy-in Stroke program essential for large hospitals May enhance image of all hospitals, increase volume and improve outcomes Procedures developed may result in cost savings for hospital and improve outcomes Board of trustees may be helpful

Forming Networks of Centers Steering committee –Establish criteria for participation –Open invitation for all to participate –Try to include whole community –Strong participation from EMS Endorsements from Medical Society Endorsements from Hospital Council –Minimal financial impact on non-participating hospitals Community groups Political support--local and national

9-1-1 Call Center Emergency Medical Dispatch Caller Accuracy is “Rate Limiting Factor” Possible Stroke v. Fall v. Diabetic Problem Key Questions –Awake? –Breathing Normally?

EMS Assessment SFFD Stroke Recognition Training –Before: 61% –After: 91% LAPSS –91% Sensitive –97% Specific

Field Neurological Exam Symmetric Smile Equal Grip Arm Drift Simple Phrase

Key Information Exact Onset of Symptoms –Bring Witnesses, Family Members History of Seizure Disorder Diabetes? –Finger Stick Glucose Previous Neurologic Status

Destination Selection Must Have Stroke System in Place 24/7 Coverage Rotating Schedule Geographic Balance Diversion Contingencies

The Future The task force envisions the development of local, and eventually state and national guidelines for stroke care delivery, including prehospital stroke care. In anticipation of these developments, this document has been created to help communities begin to pursue these goals.

Task Force Recommendations Evaluate its stroke care system capabilities regarding: –Public awareness of the signs and symptoms of stroke –Prioritization of potential stroke patients within EMS dispatch protocols –Training of EMS professionals in recognition and treatment of stroke –Uniformity of prehospital stroke care protocols among all EMS provider agencies –Uniformity of transportation algorithms and destination protocols for stroke patients –Identification of hospital resources regarding stroke care

Continued Recommendations Identify or create a community organization to implement and oversee the stroke care system Ensure competency for all components of the EMS system and participating hospitals in assessing and treating patients with acute stroke. Prioritize dispatch of acute stroke patients similar to that assigned to patients with major injury and acute myocardial infarction.

Continued Recommendations Develop triage protocols for preferential stroke patient transport (including inter-hospital transfers) to designated stroke center hospitals Collect, analyze, and share EMS and stroke center hospital data among participating EMS systems and hospitals for purposes of quality improvement and patient outcome. Develop local guidelines for stroke care delivery, including prehospital stroke care.