EMS-We Need You In The Neuroscience Know
EMS, we can’t do it without you! We’ve known EMS providers are the key to intervention and treatment for best outcomes of early care of acute strokes, and the 2013 American Heart Association/American Stroke Association Guidelines for the Early Management of Patients with Acute Ischemic Stroke support this with evidence!
When the 2007 guidelines were released, stroke was the third leading cause of death. The good news is since those recommendations have been implemented, stroke has now dropped to the fourth cause of death; however, it still remains the leading cause of disability.
The chain of action for someone having good functional outcomes after having a stroke starts with the recognition of when a stroke actually begins. It is important for EMS to help with community awareness by teaching the community the signs and symptoms of stroke using the F.A.S.T. acronym (parallel to the Cincinnati scale), reinforcing the community to recognize signs and symptoms of stroke and call 9-1-1 immediately.
F – Facial droop
A – Arm drifting
S – Speech difficulty
T – Time to call 9-1-1
Data still shows the public’s knowledge of stroke warning signs and symptoms remains at an all-time low. Fewer than half of 9-1-1 calls for stroke events were made within an hour of symptom onset according to an article entitled “Awareness of necessity to call 9-1-1 for stroke symptoms.” What is so awesome is that many studies have proven that ongoing powerful public education about the signs and symptoms of stroke does improve stroke recognition. The California Acute Stroke Pilot Registry reported the expected overall rate of clot buster tPA treatment within 3 hours could be increased from 4.3% to 28.6% if all patients arrived early, after onset of symptoms.
The guidelines are all based on research and have been tested for years in many studies. Many of our EMS providers have implemented these guidelines and best practices, but we wanted to share with you the research of why those actions were put into recommendations. Four of the recommendations remain the same as they are the best practice, and two more were added as proven scientific-based interventions for pre-hospitalization and impact actions for EMS. The recommendations are as follows:
1. To increase both the number of patients who are treated and the quality of care, educational stroke programs for physicians, hospital personnel, and EMS personnel are recommended. (Unchanged from the previous guideline)
2. Activation of the 9-1-1 system by patients or other members of the public is strongly recommended. 9-1-1 dispatchers should make stroke a priority dispatch, and transport times should be minimized. (Unchanged from the previous guideline)
3. Prehospital care providers should use prehospital stroke assessment tools, such as the Los Angeles Prehospital Stroke Screen or Cincinnati Prehospital Stroke Scale. (Unchanged from the previous guideline)
4. EMS personnel should begin the initial management of stroke in the field. Development of a stroke protocol to be used by EMS personnel is strongly encouraged. (Unchanged from the previous guideline)
5. Patients should be transported rapidly to the closest available certified Primary Stroke Center or Comprehensive Stroke Center or, if no such centers exist, the most appropriate institution that provides emergency stroke care as described in the statement. In some instances, this may involve air medical transport and hospital bypass. (Revised from the previous guideline)
6. EMS personnel should provide prehospital notification to the receiving hospital that a potential stroke patient is en route so that the appropriate hospital resources may be mobilized before patient arrival. (Revised from the previous guideline)
While Stroke Awareness Month is in May, you will see Bon Secours facilities constantly doing community outreach at every opportunity to spread the word on the signs and symptoms of stroke and emphasizing the importance to call 9-1-1 for help! Our motto at Bon Secours is Good Help to Those In Need. We need your help! Help us spread the news about the signs and symptoms of a stroke. Urge the community to call 9-1-1. Document the last known well time (no signs or symptoms of a stroke). Working together, we can help the patient suffering from a stroke.
Check out this 60-second public service announcement. Help us spread the good word to those in need!