1. Huron Perth EMS Stroke Update
Huron County Emergency Services

2. Background
Research has shown that significant patient gains can be made when stroke patients are cared for by a stroke team with expertise in stroke care
In order to be expert at stroke care, facilities need to have volumes of 165 ischemic stroke patients per year as the risk of 30- day mortality is increased for hospitals not meeting this volume
In the South West LHIN there are currently 28 hospitals providing stroke care, many of which have very low stroke volumes

3. Background Cont.
To ensure stroke patients have access to best practice stroke care, in the Spring of 2015 the South West LHIN Board approved recommendations that would result in the realignment of acute stroke care services from 28 hospitals to 4 district stroke centers and 1 telestroke site (Goderich)

4. What this means to you?
All stroke patients in Huron and Perth regions will receive best practice stroke care at Stratford General Hospital, District Stroke Centre
Implementation of this shift will occur in 2 stages:
The first stage will shift all stroke care within the Huron Perth Healthcare Alliance (HPHA) to Stratford General Hospital (SGH) Stage 1,
Target Start Date: Feb. 1st, 2016
The second stage will shift the remaining hospitals’ (Listowel, Wingham, South Huron and Alexandra Marine General Hospital (AMGH)) stroke patients to SGH
No date set

5. Stage 1
Strokes/TIAs who do not meet the prompt card criteria, that would usually go to:
Clinton Public Hospital or
Seaforth Community Hospital or
St Marys Memorial Hospital
will instead be taken directly to Stratford General Hospital by EMS
Strokes that meet the prompt card criteria will follow the current procedure and route to the closest District Stroke Centre (Stratford General) or Telestroke Centre (AMGH, Goderich) for thrombolytic consideration

6. Stage 2
In the future, the second stage will shift all stroke care from Listowel, Wingham, South Huron and Alexandra Marine General Hospital to Stratford General Hospital, District Stroke Centre
However, Strokes that meet the prompt card criteria will follow the current procedure and route to the closest District Stroke Centre (Stratford General) or Telestroke Centre (AMGH, Goderich) for thrombolytic consideration
An innovative Drip & Ship model will be developed to transfer patients who receive thrombolytic treatment at AMGH to SGH for all follow-up care

7. Paramedic Prompt Card
Stage 1 changes have been added to the backside of the prompt card for future reference
Huron and Perth EMS All potential Stroke/TIA patients that meet the prompt card criteria should go to the closest designated Stroke Centre (Stratford General Hospital) or Telestroke Centre (Alexandra Marine and General Hospital) However, for potential Stroke/TIA patients in the hospitals’ catchment area of the Huron Perth Healthcare Alliance (Clinton, Seaforth, or St. Mary’s) that do not meet the stroke protocol criteria should be taken to Stratford General Hospital, the Stroke Centre

8. What is a Stroke Unit?
A stroke unit is a specialized, geographically defined hospital unit dedicated to the management of stroke patients. (Evidence Level A)
In addition this geographically defined unit should have identifiable co-located beds occupied by stroke patients on average 75% of the time. Stroke patients should be cared for by a dedicated inter- professional team with expertise in stroke care
The core stroke unit team should consist of healthcare professionals with stroke expertise in medicine, nursing, occupational therapy, physiotherapy, speech-language pathology, social work, and clinical nutrition. (Evidence Level A)

9. Why Stroke Unit Care works?
Treatment at a stroke unit compared to treatment in a general ward
reduces mortality (absolute risk reduction of 3%)
reduces dependency (5%)
reduces need for institutional care (2%)
All types of patients, irrespective of gender, age, stroke subtype and stroke severity, appear to benefit from treatment in stroke units
Patients treated on stroke units have fewer complications, earlier recognition of pneumonia and earlier mobilization

10. Components of Stroke Unit Care
Typical components of stroke units include:
Assessment
Medical assessment and diagnosis, early assessment of nursing and therapy needs
Early management policies
Early mobilization, prevention of complications, treatment of hypoxia, hyperglycemia, pyrexia and dehydration
Ongoing rehabilitation policies
Coordinated multidisciplinary team care
Early assessments of needs after discharge

11. HPHA Integrated Stroke Unit (ISU)
In December 2014, Stratford General Hospital opened an Integrated Stroke Unit (ISU)
Located on Medicine

12. HPHA Integrated Stroke Unit (ISU)
The ISU consists of 3 acute and 5 rehab stroke beds and has a dedicated interdisciplinary team specializing in stroke best practice care
Facilitates a seamless transition of care as the patient moves from acute to rehab without changing beds/teams and then to the community via a link with the Community Stroke Rehab Team

13. Benefits of Hyper acute Care at SGH (District Stroke Centre)
By receiving emergent stroke care at the SGH Emergency department, patients have access to best practice stroke care within accepted timelines. This includes access to:
CT scan
Consult with an Internist. Internist has access to Stroke Neurology and Interventional Radiology consults
Timely access to the Secondary Stroke Prevention Clinic for TIAs and Minor Strokes
Healthcare Team with specialized knowledge in stroke assessments and treatment
Admission to the ISU at SGH

14. References www.HQOntario.ca
Stroke Unit Trialists' Collaboration Cochrane Rev (2007)
Guidelines Ischemic Stroke 2008