1. ICAHN’s Stroke Initiative 2009-2013 and beyond Funded in part by Genentech as well as Federal Flex Grant and SHIP Grant Statewide Health Improvement Program (SHIP)

2. Vision for Quality Stroke Care Elevate the quality of stroke care in the rural areas to establish access to care regardless of where a person resides or is visiting in the state of IL

3. Professional Education ICAHN Stroke Model for Training and Preparation for Emergent Stroke Ready Hospitals

4. Pact to Act FAST : Objectives Identify the purpose of the Pact initiative Learn the key components of the program Reference what research tells us about Stroke Community Education Understand why people don’t call 911 when having a stroke? How can community education impact the resistance by some Drs to administer the drug

5. Why is Community Education so Vital to Success? There is only one drug to treat stroke and it must be given within 3 hours of the onset of a stroke Most patients wait more than 3 hours to even arrive at the hospital Most patients do not arrive by EMS Most patients do not know the severe consequences of waiting to get help Our trained and ready hospitals are not able to help many patients due to the delay

6. PACT TO ACT FAST Main Thrust of Pact to Act FAST is to change behavior and increase the number of people who call 911 when stroke signs appear. – Less than half of acute stroke patients arrive via ambulance – Most stroke patients wait 6 hours or more to seek treatment for an acute stroke – Majority of people arrive beyond the 3-4 hour window for tPA eligibility

7. What is the PACT? Anytime, anywhere I observe a person with any of the FAST signs of stroke, I will call 911 immediately, even if the person says they want to wait. I know with stroke every second counts and with every second, the average stroke patient loses 32,000 brain cells. A Pact is an agreement that is not to be broken Ask everyone to take the Pact Personal Pledge and know the signs: F—FACE: Ask the person to smile. Does one side of the face droop? A—ARMS: Ask the person to raise both arms. Does one arm drift downward? S—SPEECH: Ask the person to repeat a simple phrase. Is their speech slurred or strange? T—TIME: If you observe any of these signs, call 9-1-1 immediately

8. Pact Urges Having a Plan PACT TO ACT FAST Stroke is an Emergency You have an emergency plan in case of fire You have a plan in case of a tornado What is your plan when someone has a STROKE? Call 911 – Don’t Wait

9. Pact to Act FAST TEAM Health Departments 219 Rural Health Clinics 52 CAH Parish Nurses EMS: 329 agencies Stroke Support Groups

10. Pact to Act FAST Target Audiences Schools Churches Work Places Community Organizations Small Businesses and Restaurants (posters) Other: scouts, grocery stores, stroke month events at our hospitals, senior centers

11. Resources Provided Guidebook of recommended activities Community Education PowerPoint Magnets Wallet Cards Table Tents Posters What Every Family Should Know Card Bookmarks Plan Ahead for Stroke, Fire & Tornado Card PACT Promise Cards Stroke Month Special Activities and materials

12. Outcomes 2013 to Date Outreach to Counties: 36 people signed the pledge: 9,126 Shipped pieces of materials: 72,256 Track Outcomes by: o Quantity shipped o People reached o By county o By organization type reached o By team member type providing service

13. Measure Improvement with GWTG Per Cent of patients arriving within targeted time frame Per Cent of patients receiving tPA Per Cent who arrive by ambulance Overall outcomes for our hospitals to reflect the quality available to those who arrive in time

14. Pact to Act FAST All materials are free and shipped free Available in rural areas Most are shipped within 3 days of ordering Each order is tracked for a follow up activity report

15. Community Education Challenge Studies on Effectiveness of community education for stroke signs, responding in time, knowledge of stroke: The Problem The Research The Savings The Added Benefit for Standard of Care

16. Top Ten Reasons People Don’t Call 911 Ten: They think if they go lie down they will feel better Nine: They think the signs will eventually go away Eight: They are afraid to be hospitalized Seven: They want to call someone they know to get their opinion Six:They are afraid the ambulance will arrive and their symptoms will have gone away so they want a family member to drive them Five: They are not in pain Four: They know stroke is “bad” and they are in denial of their symptoms Three: They don’t know they have just a three hour window for the best treatment Two: They are worried about the cost And the number one reason people don’t call 911 They don’t want to feel embarrassed when neighbors or coworkers see them carried out on a stretcher and hear the sirens. Don’t die of embarrassment – Call 911 to save your life.

17. Community Education for Stroke What we have learned Using all types of outreach works best: – Media, stroke materials, posters, events Colors make a difference- black and yellow Message must be repeated over a longer period of time than most communities receive Message is especially needed in at risk populations Message needs to come from a variety of teachers Seeing the message is retained slightly better than just hearing it but it is really a combination of both

18. Thank you to the hospitals recognized at the International Stroke Conference 2013 in Hawaii Thank you to all of hospitals and our partners especially Genentech, American Heart Association and the ICAHN organization.

20. Requirements: Stroke Team CAH Stroke Team Hospital and administrative support Acute stroke team ( 2 ) Written care protocols Emergency medical systems (pre) Emergency department 24/7 Transfer Agreements Neurosurgical Consult Neuro-imaging 24/7 Laboratory services 24/7 Outcomes/quality improvement Educational programs 4 units yr Community Education to reach at least 100 people each year PSC Stroke Team Hospital and administrative support Acute stroke team Written care protocols Emergency medical systems Emergency department Stroke units Neurosurgical services Neuro-imaging Laboratory services Outcomes/quality improvement Educational programs

21. Requirements: EMS and PSC Collaboration EMS Pre-notification: currently achieving 80% compliance ICAHN works with each of the EMS stroke regions 1-6 to establish a collaborative effort Coordinator attends most of the EMS regional stroke committee meetings to establish protocols, performance improvement and identify training needs. EMS regional stroke chairs receive our monthly stroke newsletter Coordinator organizes and supports rural EMS with educational opportunities Each CAH chooses their own “hub(s) PSC for transfer Each CAH establishes their own transfer agreements ICAHN collaborates with PSC for resources and education

22. Requirements: Measurement Get with the Guidelines is the standard measuring tool for the ICAHN initiative ICAHN provides a stipend for 50% of the cost for the first year and requires a 3 year commitment for continual use Our partnership with AHA provides all users with a monthly desktop sharing webinar to maximize use of the tool

23. Resources and Partnerships  ICAHN Resource Library on-line  Funding all comes through our grant partners:  Genentech, Telligen, AHA, Flex Grant, Ship Grants, Northwestern University  Coordination across 52 hospitals  Support and Recognize Stroke Champions across disciplines  Encourage and support community education

24. Outcomes 2012 Outreach to 49 Counties 15,000 people signed the pledge Shipped 50,000 pieces of materials Track Outcomes by: o Quantity shipped o People reached o By county o By organization type reached o By team member type providing service