Tenn. Bill Aims to Get Stroke Patients to Best Destinations

Chattanooga Times Free Press, Tenn.

April 11--Transporting stroke patients to the proper hospital -- not necessarily the closest -- is the rationale behind a bill recently passed by the Tennessee General Assembly.

Pending Gov. Bill Haslam's approval, the bill would establish procedures for emergency medical services to identify and quickly transport severe stroke patients to the facility best equipped to treat them.

"This legislation is the next step forward in creating a comprehensive stroke system of care throughout the state," the bill's primary sponsor, Sen. Bill Ketron, R-Murfreesboro, said in a statement. "This will ensure stroke patients get to the best stroke center as quickly as possible, and it brings Tennessee one step closer to improving stroke care."

Stroke is the fifth leading cause of death and the No. 1 cause of disability in the United States, according to the American Heart Association's website. Tennessee ranks fourth in the nation for stroke prevalence, putting it in the heart of the "stroke belt," along with Alabama, Mississippi, Louisiana and Arkansas.

Strokes occur when the brain's blood supply is interrupted. Prompt treatment is essential to restore blood flow and minimize damage.

When blood is stopped by large blockages, called emergent large vessel occlusions, research suggests the best treatment is surgery to remove the clot. However, only certain facilities are equipped to perform these procedures 24-7.

Dr. Blaise Baxter, an interventional neuroradiologist at Erlanger Health System and president of the Society of NeuroInterventional Surgery, said the bill is important, because state laws haven't been updated since these procedures became standard care, and it will help EMS triage stroke patients in a way more similar to trauma patients, who also must be quickly assessed in the field.

"Part of this whole effort is to help EMS have the tools to better recognize the stroke patients," Baxter said. "They obviously are the point of first contact with these patients, and they always want to do the right thing -- this makes them so much better equipped to get it right and have the great outcome for the patient."

The new protocols would include education for first responders in how to better identify emergent large vessel occlusion patients, including use of a mobile app designed to help EMS responders assess stroke severity in the field.

Baxter said such tools may be especially useful for rural EMS personnel, who could encounter only a handful of large vessel occlusion patients per year.

"For them, it's kind of like locating a needle in the haystack, so the app gives it to them in real time and walks them through the testing," he said.

In 2017, Rhode Island updated its EMS protocols to transport suspected severe stroke patients directly to a comprehensive stroke center if the patient is within 30 minutes of the facility. Several other states, including Arizona, Colorado, Massachusetts and Virginia, are considering similar legislation, according to the Get Ahead of Stroke Campaign website, which is advocating for the laws.