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
- Rapidly assess patient, position patient with head at 30 degrees and protect airway, manage ABCs, and obtain vital signs.
- 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.
- 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.
- Obtain IV access and monitor for cardiac dysrhythmias.
- If a possible stroke is suspected, immediately notify Med Command and receiving facility for activation of the Stroke Team.
- Rapid/timely transport of stroke patients to a certified stroke center is key. "Load and Go" to MetroHealth.
- 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.
Facial 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.
Arm 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.
Speech: 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.