Stroke Guidelines for Healthcare Providers

  • MetroHealth is nationally recognized by the American Heart Association/American Stroke Association with the Gold Plus Award for quality in stroke care and the Target: STROKE list for hospitals that demonstrate consistent ability to give tPA in < 60 minutes.
  • MetroHealth launched its Certified Primary Stroke Center — the first in Northeast Ohio — in 2004.
  • MetroHealth became a Joint Commission certified Comprehensive Stroke Center in 2014
  • Patients have access to the most advanced comprehensive stroke treatment options available 24/7 including on-site neurology and neurosurgery specialists, brain imaging scans, clot-busting medications, and advanced neuro radiology interventions.
  • Highly trained and experienced staff, including physicians that are pioneers in the advancement of stroke care treatment options.
  • MetroHealth's Stroke Center includes specialized inpatient stroke units as well as a dedicated CARF-accredited rehabilitation facility with a dedicated stroke unit.
  • At MetroHealth, physicians are actively involved in cutting edge stroke research through numerous National Institutes of Health (NIH) and industrial trials.
  • MetroHealth’s Physical Medicine & Rehabilitation physicians lead NIH researchers in studying decreased function and pain related to post-stroke weakness with Functional Electrical Stimulation (FES).
  • MetroHealth is also active in developing best practices for prevention, treatment, and rehabilitation of stroke.

Key Points for EMS Providers

  • Recognize Signs and Symptoms of Stroke
  • Rapid Pre-Hospital treatment and transfer; limit time on scene.
  • Load and Go! Time is Brain!
  • Alert Metro Health Emergency Department/Stroke Center of possible acute stroke symptoms for rapid Stroke Team activation and treatment.
  • Strongly encourage witness of event and/or family member to travel to hospital with you. 

Stroke Chain of Survival

  • Detection: Recognition of stroke signs and symptoms
  • Dispatch: Call 911 and priority EMS dispatch
  • Delivery: Prompt transport and pre-hospital notification to MetroHealth
  • Door: Immediate ED triage
  • Data: ED evaluation, prompt laboratory studies, and CT imaging
  • Decision: Diagnosis and decision about appropriate therapy
  • Drug: Administration of appropriate drugs or other interventions

Guidelines for Pre-Hospital Stroke Patient Care

  1. Rapidly assess patient, position patient with head at 30 degrees and protect airway, manage ABCs, and obtain vital signs.
  2. Rapidly assess for deficits using a stroke scale like the Cincinnati Pre-Hospital Stroke Scale. Determine and document the time when the patient was last known to be well and onset of symptoms.
  3. Check patient's blood sugar. If less than 80mg/dl, administer 50cc of 50% dextrose IV push. If greater than 400, infuse 250cc bolus of Normal Saline.
  4. Obtain IV access and monitor for cardiac dysrhythmias.
  5. If a possible stroke is suspected, immediately notify Med Command and receiving facility for activation of the Stroke Team.
  6. Rapid/timely transport of stroke patients to a certified stroke center is key. "Load and Go" to MetroHealth.
  7. MetroHealth’s Joint Commission-certified Comprehensive Stroke Center has an auto-accept policy for potential stroke victims.

Cincinnati Pre-Hospital Stroke Scale

This scale evaluates for facial palsy, arm weakness, and speech abnormalities. Items are scored as either normal or abnormal.

Stroke Face DroopFacial Droop: The patient shows teeth or smiles. 

  • Normal: Both sides of face move equally
  • Abnormal: One side of face does not move as well as the other.

 

 

Stroke IndicatorArm Drift: The patient closes their eyes and extends both arms straight out for 10 seconds. 

  • Normal: Both arms move the same, or both arms do not move at all.
  • Abnormal: One arm either does not move, or one arm drifts down compared to the other. 

 

 

Stroke SpeechSpeech: The patient repeats "You can't teach an old dog new tricks," or some other simple, familiar saying.

  • Normal: The patient says correct words with no slurring of words.
  • Abnormal: The patient slurs words, says the wrong words, or is unable to speak. 

 

Resources