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-inStroke TeamObtaining 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 hospitalsMay enhance image of all hospitals,

increase volume and improve outcomesProcedures developed may result in cost

savings for hospital and improve outcomesBoard 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 DispatchCaller Accuracy is “Rate Limiting Factor”Possible Stroke v. Fall v. Diabetic ProblemKey Questions

– Awake?– Breathing Normally?

EMS Assessment

SFFD Stroke Recognition Training– Before: 61%– After: 91%

LAPSS– 91% Sensitive– 97% Specific

Field Neurological Exam

Symmetric SmileEqual GripArm DriftSimple Phrase

Key Information

Exact Onset of Symptoms– Bring Witnesses, Family Members

History of Seizure DisorderDiabetes?

– Finger Stick GlucosePrevious Neurologic Status

Destination Selection

Must Have Stroke System in Place24/7 CoverageRotating ScheduleGeographic BalanceDiversion 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.