Update: Effective June 1, 2011 the Tidewater Stroke Triage Plan was revised to delete references to the "Acute Stroke ED". All acute stroke patients should be transported to the closest Designated Stroke Center unless otherwise directed by medical control.
Over a year ago the Council's EMS Performance Improvement (PI) Committee tasked a smaller workgroup with creating a regional stroke triage plan. This smaller workgroup was formed of EMS, emergency department, hospital stroke coordinators and OMD representatives. This plan was sketched out, torn apart and revised multiple times during the developmental stages. In December 2010 a final draft of the Tidewater EMS Prehospital and Interhospital Regional Stroke Triage Plan was sent to the regional Operational Medical Directors Committee and approved with an implementation date of April 1.
A challenge in writing the plan was stroke patient destination. The group debated criteria but decided, no matter what, priority should be given to patient advocacy. In the end, the plan calls for hospitals to be identified as an “Acute Stroke ED” or as a “Designated Stroke Center”. A hospital with an “Acute Stroke ED” has available 24/7 resources like thrombolytics, brain imaging and available neurology consult while the Designated Stroke Center has also achieved Primary Stroke Center Certification by the Joint Commission which accredits hospitals. All hospitals in the Tidewater region except Southampton Memorial provide one of these two levels of acute stroke care.
For determining the severity of stroke, the regional plan embraces the Cincinnati Prehospital Stroke Scale which was previously incorporated in the regional stroke protocol.
The plan emphasizes the need to expedite transport of an acute stroke patient within a three‐hour window between stroke onset and definitive care. EMS providers are urged to make time and distance decisions, including the possible use of air transport, to achieve this three-hour window.
In cases where an “Acute Stroke ED” and a “Designated Stoke Center” are equal in terms of transport time, the destination should be the Designated Stroke Center. At other times, when an “Acute Stroke ED” is closer by time, it should be the destination.
EMS providers in this region will not see a huge difference in treatment or transport of stroke patients. Western Tidewater agencies will need to work closely with Southampton Memorial and its surrounding hospitals surrounding to ensure the best and most timely care for the stroke patient.
An EMS provider always has access to on-line medical control who can answer questions, help determine if the patient meets the criteria as an acute stroke patient, and help with transport decisions.