EMS stroke systems of care in the US

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In the United States, current best practices for potential victims of stroke focus on the goals of rapid EMS triage of, transport to and treatment at Primary Stroke Centers. This session will address the following questions:
-What is the best EMS Stroke Care Model to accomplish this?
-Is there only one “Best Model”?
-How do models compare with other systems in neighboring states and elsewhere in the U.S.?
-What aspects of these other models might be adapted by EMS care systems to improve stroke care?

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  • Figure 2. Geospatial Information Systems (GIS) map displaying TJC primary stroke centers and state-certified or other stroke centers and the distance to the nearest TJC primary stroke center for the US population by county. Source: ESRI 2007. Joint Commission Primary Stroke Centers and State-Designated Stroke Centers as publicly reported on 1/1/09.
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  • EMS stroke systems of care in the US

    1. 1. EMS Models for Stoke Care:Best Practices from CT and Around the United States Rommie L. Duckworth, LP 1
    2. 2. Presenter Disclosure InformationRommie L. Duckworth, LPFINANCIAL DISCLOSURE:[No relevant financial relationship exists]UNLABELED/UNAPPROVED USES DISCLOSURE:[IA tPA, Surgical Clot Removal] 2
    3. 3. Target Stroke: EMS & Acute Care 1 The sooner that rt-PA is given to stroke patients, the greater the benefit, especially if started within 2 90 minutes of symptom onset.
    4. 4. Opportunity to Improve Timeliness of IV rt-PA in Ischemic Stroke Door-to-IV rt-PA within 60 minutes 3 4GWTG-Stroke Database, data on file DCRI
    5. 5. Opportunity to Improve Admin. of IV rt-PA in Ischemic Stroke 5 % Stroke Patients who Receive rt-PA
    6. 6. Connecticut Comprehensive Plan for Stroke Prevention and Care Goals 6• Plan Goal: To create a coordinated system of stroke care and prevention in which it is possible for every Connecticut resident to access appropriate and timely care for optimal post stroke outcomes. A coordinated care system involves EMS, hospital stroke teams, specialized stroke units (where applicable), and standardized care protocols.• Emergency Medical Services (EMS): To facilitate timely access to EMS care, enhanced pre-hospital recognition and treatment, and rapid transport to the appropriate health care facility of patients experiencing a stroke event.
    7. 7. 7 8Copyright © American Heart Association
    8. 8. Decrease Door to Treatment Time• Dispatch – Decrease Time To 911 Notification – Prioritizing EMS Dispatch – Assuring Correct EMS Resources
    9. 9. Decrease Door to Treatment Time• Notification – Correctly Identifying Stroke In The Field – ED Pre-notification – Aggregating Data To Facilitate ED Assessment
    10. 10. Decrease Door to Treatment Time• Treatment / Transport – Triage To Best Destination – Extending The Time Frame – Reducing The Distance
    11. 11. Which of these do you most see a need to improve in your organization?a. Dispatchb. Notificationc. Treatment / Transport 11
    12. 12. Which of these do you feel able to affect through your organization?a. Dispatchb. Notificationc. Treatment / Transport 12
    13. 13. Psychosocial Barriers: EMS Staff
    14. 14. How many EMS Staff barriers currently affect your organization?a. None of theseb. One of thesec. Many of thesed. All of thesee. Others 14
    15. 15. Psychosocial Barriers: ED Staff• May be too busy to receive alerts• May be unfamiliar with EMS protocols• May not trust EMS Dx• May see EMS over-triage as “crying wolf”• May perceive poor hand-off information• May have different in-house vs EMS criteria
    16. 16. How many ED Staff barriers currently affect your organization?a. None of theseb. One of thesec. Many of thesed. All of thesee. Others 16
    17. 17. Best Practices: Dispatch
    18. 18. Best Practices: Notify
    19. 19. Best Practices: Triage / Treatment
    20. 20. Best Practices: Triage / Treatment
    21. 21. Summary
    22. 22. Questions?
    23. 23. Special Thanks• Heather Duggan, RN – Stroke Coordinator, Western Connecticut Health Network
    24. 24. Contact• Rommie L. Duckworth – Director, New England Center for Rescue and Emergency Medicine – romduckworth@NECREM.org – www.NECREM.org
    25. 25. Citations1 The Role of EMS in the Management of Acute Stroke: Triage, Treatment, and Stroke Symptoms,NAEMSP Position Statement, Prehospital Emergency Care, 20072 Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, andNINDS rt-PA stroke trials, Lancet. 2004;363:768-74.3 Revised and Updated Recommendations for the Establishment of Primary Stroke Centers : ASummary Statement From the Brain Attack Coalition, Stroke. 2011;published online, 2011 AmericanHeart Association, Inc4 Data quality in the American Heart Association Get With The Guidelines-Stroke (GWTG-Stroke):Results from a National Data Validation Audit, American Heart Journal. 2012;392-398, 2012 Elsevier5 Acute stroke care in the US:Results from 4 pilot prototypes of the Paul Coverdell National AcuteStroke Registry, Stroke. 2005;36:1232-1240.6 Connecticut Comprehensive Plan for Stroke Care and Prevention 2009-2013, 2009 ConnecticutDepartment of Public Health7 Translating Evidence Into Practice: A Decade of Efforts by the American HeartAssociation/American Stroke Association to Reduce Death and Disability Due to Stroke, Stroke.2010;41:1051-1065, 2010 American Heart Association, Inc8 Expansion of the Time Window for Treatment of Acute Ischemic Stroke With Intravenous TissuePlasminogen Activator, Stroke. 2009;40:2945-2948, 2009 American Heart Association, Inc

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