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?

1. EMS Models for Stoke Care:
Best Practices from CT and Around the United States
Rommie L. Duckworth, LP 1

2. Presenter Disclosure Information
Rommie L. Duckworth, LP
FINANCIAL DISCLOSURE:
[No relevant financial relationship exists]
UNLABELED/UNAPPROVED USES DISCLOSURE:
[IA tPA, Surgical Clot Removal]
2

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. Opportunity to Improve Timeliness
of IV rt-PA in Ischemic Stroke
Door-to-IV rt-PA within 60 minutes 3
4
GWTG-Stroke Database, data on file DCRI

5. Opportunity to Improve Admin.
of IV rt-PA in Ischemic Stroke
5
% Stroke Patients who Receive rt-PA

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
8
Copyright © American Heart Association

8. Decrease Door to Treatment Time
• Dispatch
– Decrease Time To 911 Notification
– Prioritizing EMS Dispatch
– Assuring Correct EMS Resources

9. Decrease Door to Treatment Time
• Notification
– Correctly Identifying Stroke In The Field
– ED Pre-notification
– Aggregating Data To Facilitate ED Assessment

10. Decrease Door to Treatment Time
• Treatment / Transport
– Triage To Best Destination
– Extending The Time Frame
– Reducing The Distance

11. Which of these do you most see a need
to improve in your organization?
a. Dispatch
b. Notification
c. Treatment / Transport
11

12. Which of these do you feel able to
affect through your organization?
a. Dispatch
b. Notification
c. Treatment / Transport
12

13. Psychosocial Barriers: EMS Staff

14. How many EMS Staff barriers currently
affect your organization?
a. None of these
b. One of these
c. Many of these
d. All of these
e. Others
14

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. How many ED Staff barriers currently
affect your organization?
a. None of these
b. One of these
c. Many of these
d. All of these
e. Others
16

17. Best Practices: Dispatch

18. Best Practices: Notify

19. Best Practices: Triage / Treatment

20. Best Practices: Triage / Treatment

21. Summary

22. Questions?

23. Special Thanks
• Heather Duggan, RN
– Stroke Coordinator, Western Connecticut Health Network

24. Contact
• Rommie L. Duckworth
– Director, New England Center for Rescue and Emergency Medicine
– romduckworth@NECREM.org
– www.NECREM.org

25. Citations
1 The Role of EMS in the Management of Acute Stroke: Triage, Treatment, and Stroke Symptoms,
NAEMSP Position Statement, Prehospital Emergency Care, 2007
2 Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and
NINDS rt-PA stroke trials, Lancet. 2004;363:768-74.
3 Revised and Updated Recommendations for the Establishment of Primary Stroke Centers : A
Summary Statement From the Brain Attack Coalition, Stroke. 2011;published online, 2011 American
Heart Association, Inc
4 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 Elsevier
5 Acute stroke care in the US:Results from 4 pilot prototypes of the Paul Coverdell National Acute
Stroke Registry, Stroke. 2005;36:1232-1240.
6 Connecticut Comprehensive Plan for Stroke Care and Prevention 2009-2013, 2009 Connecticut
Department of Public Health
7 Translating Evidence Into Practice: A Decade of Efforts by the American Heart
Association/American Stroke Association to Reduce Death and Disability Due to Stroke, Stroke.
2010;41:1051-1065, 2010 American Heart Association, Inc
8 Expansion of the Time Window for Treatment of Acute Ischemic Stroke With Intravenous Tissue
Plasminogen Activator, Stroke. 2009;40:2945-2948, 2009 American Heart Association, Inc